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General NPI Number Information
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NPI Number | 1033727227
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Entity Type | Individual
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Provider Name | HALEY LEVERETT
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Gender | Female
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Dates
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Enumeration Date | 07/14/2020
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Last Update Date | 09/20/2021
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Provider Practice Location Address
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Address Line | 1500 S MAIN ST
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City | FORT WORTH
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State | TX
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Zip | 76104-4917
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Country | US
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Telephone | 214-702-1346
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Fax |
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Provider Business Mailing Address
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Address Line | 8105 HALLMARK DR
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City | NORTH RICHLAND HILLS
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State | TX
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Zip | 76182-8645
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 65409
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License Number State | TX
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