Healthcare Provider Details

I. General information

NPI: 1265601538
Provider Name (Legal Business Name): LEONARDS PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 11/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 SCURRY ST
BIG SPRING TX
79720-2722
US

IV. Provider business mailing address

701 SCURRY ST
BIG SPRING TX
79720-2722
US

V. Phone/Fax

Practice location:
  • Phone: 432-714-4707
  • Fax: 432-714-4709
Mailing address:
  • Phone: 432-714-4707
  • Fax: 432-714-4709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number00959
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number00959
License Number StateTX

VIII. Authorized Official

Name: MS. FRAN A TURRENTINE
Title or Position: BOOKKEEPER
Credential:
Phone: 432-714-4707