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NPI Code Detail

MEDICARE: LEAH DOUBLE

MEDICARE:   LEAH  DOUBLE
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
1183500000XPharmacist5302041385MI

General Provider Information

NPI Number : 1710430517
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEAH DOUBLE
Provider Business Mailing Address
First Line : 5350 W MAIN ST
Second Line :
City : KALAMAZOO
State : MI
Zip : 49009-3304
Country : US
Telephone Number : 269-349-6290
Fax Number :
Provider Business Practice Location Address
First Line : 5350 W MAIN ST
Second Line :
City : KALAMAZOO
State : MI
Zip : 49009-3304
Country : US
Telephone Number : 269-349-6290
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2016
Last Update Date : 07/27/2016

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Directions to “ LEAH DOUBLE ” Practice Location

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