Provider Demographics
NPI:1306843206
Name:LECKBAND, SUSAN GRACE (RPH, BCPP)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:GRACE
Last Name:LECKBAND
Suffix:
Gender:F
Credentials:RPH, BCPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3350 LA JOLLA VILLAGE DR
Mailing Address - Street 2:119
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1806
Mailing Address - Country:US
Mailing Address - Phone:858-552-8585
Mailing Address - Fax:858-552-4336
Practice Address - Street 1:3350 LA JOLLA VILLAGE DR
Practice Address - Street 2:119
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1806
Practice Address - Country:US
Practice Address - Phone:858-552-8585
Practice Address - Fax:858-552-4336
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA479071835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric