Provider Demographics
NPI:1366798829
Name:LEONG, ALAN T
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:T
Last Name:LEONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 N NEVADA CT
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-8163
Mailing Address - Country:US
Mailing Address - Phone:509-943-8358
Mailing Address - Fax:
Practice Address - Street 1:101 WELLSIAN WAY
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4150
Practice Address - Country:US
Practice Address - Phone:509-943-8358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00018231183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist