Provider Demographics
NPI:1730944596
Name:DE-SOUZA, LEROI (PHARMD)
Entity type:Individual
Prefix:
First Name:LEROI
Middle Name:
Last Name:DE-SOUZA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 W CLEARWATER AVE APT E202
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2089
Mailing Address - Country:US
Mailing Address - Phone:323-434-7197
Mailing Address - Fax:
Practice Address - Street 1:1601 GEORGE WASHINGTON WAY
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99354-2626
Practice Address - Country:US
Practice Address - Phone:509-943-2605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH61461662183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist