Provider Demographics
NPI:1811172984
Name:LEO, GARY LOUIS (RPH)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:LOUIS
Last Name:LEO
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 1:476 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14206-1538
Mailing Address - Country:US
Mailing Address - Phone:716-847-0424
Mailing Address - Fax:716-847-0769
Practice Address - Street 1:476 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14206-1538
Practice Address - Country:US
Practice Address - Phone:716-847-0424
Practice Address - Fax:716-847-0769
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0466551183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist