Healthcare Provider Details

I. General information

NPI: 1578070751
Provider Name (Legal Business Name): LELAND SUMRALL PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 01/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30304 HIGHWAY 21
ANGIE LA
70426-4264
US

IV. Provider business mailing address

30304 HIGHWAY 21
ANGIE LA
70426-4264
US

V. Phone/Fax

Practice location:
  • Phone: 985-986-4433
  • Fax: 985-986-4900
Mailing address:
  • Phone: 985-986-4433
  • Fax: 985-986-4900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17192
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: