Provider Demographics
NPI:1245079318
Name:CHOICE PARENTERAL NUTRITION, LLC
Entity type:Organization
Organization Name:CHOICE PARENTERAL NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:916-999-0301
Mailing Address - Street 1:4600 NORTHGATE BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1159
Mailing Address - Country:US
Mailing Address - Phone:916-999-0301
Mailing Address - Fax:
Practice Address - Street 1:4600 NORTHGATE BLVD STE 120
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-1159
Practice Address - Country:US
Practice Address - Phone:916-999-0301
Practice Address - Fax:916-999-0234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy