Basic Information
| Provider Information | |||||||||
| NPI: | 1467174490 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ARZU | ||||||||
| FirstName: | LEO | ||||||||
| MiddleName: | |||||||||
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| Credential: | PHARMACIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5650 RED BUG LAKE RD | ||||||||
| Address2: | |||||||||
| City: | WINTER SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327084904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4076990781 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5650 RED BUG LAKE RD | ||||||||
| Address2: | |||||||||
| City: | WINTER SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327084904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4076990781 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2022 | ||||||||
| LastUpdateDate: | 09/15/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PS62873 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Pharmacy Service Providers | Pharmacist |
ID Information
| ID | Type | State | Issuer | Description | 2102663 | 01 | FL | EMPLOYEE ID | OTHER |