MEDICARE: DR. AMY MARIE LEIDAL PHARMD

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	50151	TX

General Provider Information

NPI Number	:	1336424381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY MARIE LEIDAL PHARMD

Provider Business Mailing Address
First Line	:	5015 S IH 35
Second Line	:	SUITE 200
City	:	AUSTIN
State	:	TX
Zip	:	78744-2713
Country	:	US
Telephone Number	:	512-804-3203
Fax Number	:

Provider Business Practice Location Address
First Line	:	5015 S IH 35
Second Line	:	SUITE 200
City	:	AUSTIN
State	:	TX
Zip	:	78744-2713
Country	:	US
Telephone Number	:	512-804-3203
Fax Number	:

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

Provider Enumeration Date	:	10/20/2011
Last Update Date	:	11/23/2015

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