Healthcare Provider Details

I. General information

NPI: 1316179609
Provider Name (Legal Business Name): RHIANNON MARIE LEUTNER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 08/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 MEADOWLARK ST
SHAW A F B SC
29152-5019
US

IV. Provider business mailing address

431 MEADOWLARK STREET SHAW AFB, SC 29153
APO AA
29153
US

V. Phone/Fax

Practice location:
  • Phone: 803-895-6429
  • Fax:
Mailing address:
  • Phone: 803-895-6429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number17320
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: