MEDICARE: DR. LEONARD LEVI EDLOE PHARM.D.

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
1	183500000X	Pharmacist	0202004323	VA

General Provider Information

NPI Number	:	1205832672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEONARD LEVI EDLOE PHARM.D.

Provider Business Mailing Address
First Line	:	6044 TURKEY HOLLOW PL
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23111-6963
Country	:	US
Telephone Number	:	804-781-0317
Fax Number	:	804-781-0317

Provider Business Practice Location Address
First Line	:	1124 N 25TH ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23223-5256
Country	:	US
Telephone Number	:	804-643-5721
Fax Number	:	804-644-5301

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	07/08/2007

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