Provider Demographics
NPI:1902442387
Name:LEO SALUTEM INC
Entity Type:Organization
Organization Name:LEO SALUTEM INC
Other - Org Name:LYONS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:619-407-5555
Mailing Address - Street 1:642 PALOMAR ST STE 410
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-2629
Mailing Address - Country:US
Mailing Address - Phone:619-407-5555
Mailing Address - Fax:619-407-6718
Practice Address - Street 1:642 PALOMAR ST STE 410
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-2629
Practice Address - Country:US
Practice Address - Phone:619-407-5555
Practice Address - Fax:619-407-6718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-20
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1902442387Medicaid