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General NPI Number Information
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NPI Number | 1518530047
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Entity Type | Individual
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Provider Name | SANDRA JANE LEO PHARMD
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Gender | Female
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Dates
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Enumeration Date | 07/22/2021
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Last Update Date | 07/22/2021
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Provider Practice Location Address
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Address Line | 200 ELM ST N
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City | ONAMIA
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State | MN
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Zip | 56359-7901
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Country | US
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Telephone | 320-532-2491
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Fax | 320-532-2499
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Provider Business Mailing Address
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Address Line | 148 MAIN ST APT 7
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City | FORESTON
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State | MN
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Zip | 56330-9427
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Country | US
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Telephone | 612-501-3979
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Fax | 320-532-2499
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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 | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 125156
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License Number State | MN
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