MEDICARE: VINCENT J LEINHAUSER R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	36277	TX

General Provider Information

NPI Number	:	1205163656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCENT J LEINHAUSER R.PH.

Provider Business Mailing Address
First Line	:	2315 W WASHINGTON ST
Second Line	:
City	:	STEPHENVILLE
State	:	TX
Zip	:	76401-3805
Country	:	US
Telephone Number	:	254-965-2587
Fax Number	:	254-965-5292

Provider Business Practice Location Address
First Line	:	2315 W WASHINGTON ST
Second Line	:
City	:	STEPHENVILLE
State	:	TX
Zip	:	76401-3805
Country	:	US
Telephone Number	:	254-965-2587
Fax Number	:	254-965-5292

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2009
Last Update Date	:	11/05/2009

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