Healthcare Provider Details

I. General information

NPI: 1548894702
Provider Name (Legal Business Name): GREG LEINEN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2020
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 CHATBURN AVE
HARLAN IA
51537-1845
US

IV. Provider business mailing address

701 SOUTH ST
MANNING IA
51455-1532
US

V. Phone/Fax

Practice location:
  • Phone: 712-755-2525
  • Fax: 712-755-3040
Mailing address:
  • Phone: 712-269-1463
  • Fax: 712-755-3040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21280
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: