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NPI Code Detail

MEDICARE: LEESA MARIE PRUNTY PHARMD, BCPS, BCPPS

MEDICARE: LEESA MARIE PRUNTY PHARMD, BCPS, BCPPS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistRP0007676WV
21835P0200XPediatric Pharmacist8150569OH
31835P1200XPharmacotherapy Pharmacist3121548OH
4183500000XPharmacist03132315OH

General Provider Information

NPI Number : 1023678083
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEESA MARIE PRUNTY PHARMD, BCPS, BCPPS
Provider Business Mailing Address
First Line : 11435 WOODIEBROOK RD
Second Line :
City : CHARDON
State : OH
Zip : 44024-8472
Country : US
Telephone Number : 440-667-0971
Fax Number :
Provider Business Practice Location Address
First Line : 11100 EUCLID AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44106-1716
Country : US
Telephone Number : 216-286-8035
Fax Number : 216-201-6693
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2019
Last Update Date : 06/20/2019

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Directions to “ LEESA MARIE PRUNTY PHARMD, BCPS, BCPPS” Practice Location

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