MEDICARE: LUCY LEIENDECKER PHARMD

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	03135940	OH
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	03135940	OH

General Provider Information

NPI Number	:	1467905760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCY LEIENDECKER PHARMD

Provider Business Mailing Address
First Line	:	3965 HOOK RD
Second Line	:
City	:	CRESTLINE
State	:	OH
Zip	:	44827-9687
Country	:	US
Telephone Number	:	419-631-1360
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 LEXINGTON AVE
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44907-2632
Country	:	US
Telephone Number	:	419-756-7023
Fax Number	:

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

Provider Enumeration Date	:	08/03/2016
Last Update Date	:	11/21/2020

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