Provider Demographics
NPI:1396049409
Name:LEONG, SUSAN LIOU (RPH)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LIOU
Last Name:LEONG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 BALBOA BLVD UNIT M10
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-2709
Mailing Address - Country:US
Mailing Address - Phone:818-454-9607
Mailing Address - Fax:
Practice Address - Street 1:5301 BALBOA BLVD UNIT M10
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-2709
Practice Address - Country:US
Practice Address - Phone:818-454-9607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-04
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55718183500000X
CO13927183500000X
MO042214183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO042214OtherBOARD OF PHARMACY
CA55718OtherBOARD OF PHARMACY
CO13927OtherBOARD OF PHARMACY