Healthcare Provider Details

I. General information

NPI: 1598491672
Provider Name (Legal Business Name): LEANNA ROACH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2022
Last Update Date: 11/02/2024
Certification Date: 11/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 PICKWICK ST
SAVANNAH TN
38372-3053
US

IV. Provider business mailing address

775 PICKWICK ST
SAVANNAH TN
38372-3053
US

V. Phone/Fax

Practice location:
  • Phone: 731-925-6200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-100808
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number46225
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: