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General NPI Number Information
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NPI Number | 1801407663
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Entity Type | Individual
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Provider Name | LEONDRA NICOLE EWING
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Gender | Female
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Dates
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Enumeration Date | 08/13/2020
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Last Update Date | 08/13/2020
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Provider Practice Location Address
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Address Line | 12750 JEFFERSON AVE
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City | NEWPORT NEWS
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State | VA
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Zip | 23602-4318
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Country | US
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Telephone | 757-272-9981
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Fax |
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Provider Business Mailing Address
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Address Line | 520 DARTMOOR DR APT 101
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City | NEWPORT NEWS
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State | VA
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Zip | 23608-8041
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Country | US
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Telephone | 757-272-9981
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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 | 0202218168
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License Number State | VA
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