Healthcare Provider Details

I. General information

NPI: 1366618134
Provider Name (Legal Business Name): REBECCA ANN LEAVITT PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 N MAIN ST
CEDAR CITY UT
84720-9113
US

IV. Provider business mailing address

297 N TORREY PINES CIR
CEDAR CITY UT
84720-6962
US

V. Phone/Fax

Practice location:
  • Phone: 435-865-0218
  • Fax: 435-865-0228
Mailing address:
  • Phone: 702-236-7886
  • Fax: 435-868-5450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number372161-1701
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: