Healthcare Provider Details

I. General information

NPI: 1679881916
Provider Name (Legal Business Name): LEISHA SYKES R.PH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2010
Last Update Date: 09/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7105 COCKRUM ST
OLIVE BRANCH MS
38654-1629
US

IV. Provider business mailing address

7105 COCKRUM ST
OLIVE BRANCH MS
38654-1629
US

V. Phone/Fax

Practice location:
  • Phone: 662-895-2116
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE08968
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: