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General NPI Number Information
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NPI Number | 1396811857
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Entity Type | Individual
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Provider Name | SAMUEL EDWARD LEVERITT PHARM.D., BCNP
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Gender | Male
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 12/02/2014
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Provider Practice Location Address
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Address Line | 3040 E ELM ST
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City | SPRINGFIELD
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State | MO
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Zip | 65802-2632
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Country | US
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Telephone | 417-831-5190
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Fax | 417-831-5517
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Provider Business Mailing Address
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Address Line | 807 E BAYSHORE DR
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City | OZARK
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State | MO
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Zip | 65721-4247
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Country | US
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Telephone | 417-300-4090
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Fax | 417-831-5517
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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 | 2001024195
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 007349
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 1835N0905X
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Taxonomy Name | Nuclear Pharmacist
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License Number | 2001024195
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 1835N0905X
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Taxonomy Name | Nuclear Pharmacist
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License Number | 007349
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License Number State | AR
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