MEDICARE: DR. WAYNE RICHARD LEISS R.PH., 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	03-3-26748	OH

General Provider Information

NPI Number	:	1922173319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WAYNE RICHARD LEISS R.PH., PHARMD.

Provider Business Mailing Address
First Line	:	3130 N COUNTY ROAD 25A
Second Line	:
City	:	TROY
State	:	OH
Zip	:	45373-1309
Country	:	US
Telephone Number	:	937-440-4262
Fax Number	:	937-440-4265

Provider Business Practice Location Address
First Line	:	3130 N COUNTY ROAD 25A
Second Line	:
City	:	TROY
State	:	OH
Zip	:	45373-1309
Country	:	US
Telephone Number	:	937-440-4262
Fax Number	:	937-440-4265

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

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	01/14/2023

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