Provider Demographics
NPI:1295335818
Name:LEOPOLD, VICTOR (RPH)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:LEOPOLD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11909 STREAMSIDE DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-4830
Mailing Address - Country:US
Mailing Address - Phone:513-310-3892
Mailing Address - Fax:
Practice Address - Street 1:3450 VALLEY PLAZA PKWY
Practice Address - Street 2:
Practice Address - City:FT WRIGHT
Practice Address - State:KY
Practice Address - Zip Code:41017-8113
Practice Address - Country:US
Practice Address - Phone:859-341-3714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-01
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY009258183500000X
OH03116804183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist