MEDICARE: KEVIN C LEACH RPH

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	3262	MT

General Provider Information

NPI Number	:	1245259522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN C LEACH RPH

Provider Business Mailing Address
First Line	:	97 GREENWOOD DR
Second Line	:
City	:	HELENA
State	:	MT
Zip	:	59601-0373
Country	:	US
Telephone Number	:	406-443-8724
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 WILLIAMS STREET
Second Line	:
City	:	FT. HARRISON
State	:	MT
Zip	:	59636
Country	:	US
Telephone Number	:	406-447-7571
Fax Number	:	406-447-7569

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/08/2007

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Directions to “ KEVIN C LEACH RPH” Practice Location

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