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General NPI Number Information
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NPI Number | 1922173319
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Entity Type | Individual
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Provider Name | WAYNE RICHARD LEISS R.PH., PHARMD.
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Gender | Male
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 01/14/2023
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Provider Practice Location Address
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Address Line | 3130 N COUNTY ROAD 25A
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City | TROY
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State | OH
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Zip | 45373-1309
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Country | US
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Telephone | 937-440-4262
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Fax | 937-440-4265
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Provider Business Mailing Address
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Address Line | 3130 N COUNTY ROAD 25A
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City | TROY
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State | OH
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Zip | 45373-1309
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Country | US
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Telephone | 937-440-4262
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Fax | 937-440-4265
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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 | 03-3-26748
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License Number State | OH
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