Healthcare Provider Details

I. General information

NPI: 1295022275
Provider Name (Legal Business Name): LEONARD ELLIS WRYTER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 06/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8340 SUDLEY RD
MANASSAS VA
20109-3428
US

IV. Provider business mailing address

8340 SUDLEY RD T-1089
MANASSAS VA
20109-3428
US

V. Phone/Fax

Practice location:
  • Phone: 703-392-3634
  • Fax: 703-392-3634
Mailing address:
  • Phone: 703-392-3634
  • Fax: 703-392-3634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202207562
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: