Active NPI
Desty Jesus Leyson, PHARMD
- Pharmacist
- San Bernardino, CA
National Provider Identifier
1679212492
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 85558
- Practice address
- 1540 E Highland Ave
San Bernardino, CA 92404-4614 - Phone
- (909) 886-4981
- NPI assigned
- May 31, 2022
- Last updated
- Sep 7, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 85558 | CA | Primary |
Addresses
Primary practice location
1540 E Highland Ave
San Bernardino, CA 92404-4614
Mailing address
1540 E Highland Ave
San Bernardino, CA 92404-4614
Other practice location 1
618 E Barbara Ave
West Covina, CA 91790-4211
Phone (626) 622-2335
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 85558 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Longs Drug Store California LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1653955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1662508800000",
"number": "1679212492",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1540 E HIGHLAND AVE",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924044614"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1540 E HIGHLAND AVE",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924044614",
"telephone_number": "909-886-4981"
}
],
"practiceLocations": [
{
"address_1": "618 E Barbara Ave",
"address_purpose": "LOCATION",
"city": "West Covina",
"state": "CA",
"postal_code": "917904211",
"country_code": "US",
"telephone_number": "626-622-2335",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LEYSON",
"first_name": "DESTY",
"middle_name": "JESUS",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-05-31",
"last_updated": "2022-09-07",
"certification_date": "2022-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "85558",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Bernardino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.