Healthcare Provider Details

I. General information

NPI: 1538805718
Provider Name (Legal Business Name): LEANNE OLNEY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date: 02/05/2023
Reactivation Date: 05/26/2023

III. Provider practice location address

20040 N 19TH AVE
PHOENIX AZ
85027-4255
US

IV. Provider business mailing address

20040 N 19TH AVE
PHOENIX AZ
85027-4255
US

V. Phone/Fax

Practice location:
  • Phone: 623-869-5000
  • Fax:
Mailing address:
  • Phone: 623-869-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberS025387
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: