Healthcare Provider Details

I. General information

NPI: 1043142342
Provider Name (Legal Business Name): HEATHER RAYCHEL LEEZER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W MAIN ST
RUSSELLS POINT OH
43348-7500
US

IV. Provider business mailing address

120 W MAIN ST
RUSSELLS POINT OH
43348-7500
US

V. Phone/Fax

Practice location:
  • Phone: 937-292-5024
  • Fax: 937-292-3576
Mailing address:
  • Phone: 937-292-5024
  • Fax: 937-292-3576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03222916
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: