MEDICARE: LEONARD J PURULL RPH

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	923240	WI

General Provider Information

NPI Number	:	1285988857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONARD J PURULL RPH

Provider Business Mailing Address
First Line	:	291 S MAIN ST
Second Line	:
City	:	CLINTONVILLE
State	:	WI
Zip	:	54929-1604
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	291 S MAIN ST
Second Line	:
City	:	CLINTONVILLE
State	:	WI
Zip	:	54929-1604
Country	:	US
Telephone Number	:	715-823-2350
Fax Number	:	715-823-2541

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

Provider Enumeration Date	:	11/05/2012
Last Update Date	:	11/05/2012

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