Healthcare Provider Details

I. General information

NPI: 1861140634
Provider Name (Legal Business Name): LEANNA MARIE USNIK PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2022
Last Update Date: 03/11/2022
Certification Date: 03/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E LANCASTER AVE
WYNNEWOOD PA
19096-3450
US

IV. Provider business mailing address

100 E LANCASTER AVE
WYNNEWOOD PA
19096-3450
US

V. Phone/Fax

Practice location:
  • Phone: 484-744-2727
  • Fax:
Mailing address:
  • Phone: 484-744-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRP451735
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: