Healthcare Provider Details

I. General information

NPI: 1336348564
Provider Name (Legal Business Name): LEANNE ST.LEDGER PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 05/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3312 NORTHSIDE DR #409
KEY WEST FL
33040
US

IV. Provider business mailing address

3312 NORTHSIDE DR #409
KEY WEST FL
33040-4120
US

V. Phone/Fax

Practice location:
  • Phone: 850-294-4671
  • Fax:
Mailing address:
  • Phone: 850-294-4671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS41682
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: