Healthcare Provider Details

I. General information

NPI: 1245819655
Provider Name (Legal Business Name): LEAP INDUSTRIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2021
Last Update Date: 10/22/2021
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6509 HIGHWAY 41A STE B
PLEASANT VIEW TN
37146-7171
US

IV. Provider business mailing address

6509 HIGHWAY 41A
PLEASANT VIEW TN
37146-7170
US

V. Phone/Fax

Practice location:
  • Phone: 615-247-8602
  • Fax: 615-247-8616
Mailing address:
  • Phone: 615-247-8602
  • Fax: 615-247-8616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. JEREMY MUZZALL
Title or Position: PHARMACIST IN CHARGE
Credential: PHARM D.
Phone: 931-206-2975