MEDICARE: DR. SAMUEL EDWARD LEVERITT PHARM.D., BCNP

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	2001024195	MO
2	183500000X	Pharmacist	007349	AR
3	1835N0905X	Nuclear Pharmacist	2001024195	MO
4	1835N0905X	Nuclear Pharmacist	007349	AR

General Provider Information

NPI Number	:	1396811857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL EDWARD LEVERITT PHARM.D., BCNP

Provider Business Mailing Address
First Line	:	807 E BAYSHORE DR
Second Line	:
City	:	OZARK
State	:	MO
Zip	:	65721-4247
Country	:	US
Telephone Number	:	417-300-4090
Fax Number	:	417-831-5517

Provider Business Practice Location Address
First Line	:	3040 E ELM ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65802-2632
Country	:	US
Telephone Number	:	417-831-5190
Fax Number	:	417-831-5517

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	12/02/2014

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