Healthcare Provider Details

I. General information

NPI: 1821187949
Provider Name (Legal Business Name): LEONARD DANIEL HARRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 RAVEN RD
RAVEN VA
24639
US

IV. Provider business mailing address

314 LEE ST
RICHLANDS VA
24641-2428
US

V. Phone/Fax

Practice location:
  • Phone: 276-964-9095
  • Fax: 276-963-9395
Mailing address:
  • Phone: 276-963-3285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202004234
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: