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NPI Code Detail

MEDICARE: TERRY LEUENHAGEN PHARMD

MEDICARE: TERRY LEUENHAGEN 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
1183500000XPharmacistP6290ID

General Provider Information

NPI Number : 1437482122
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERRY LEUENHAGEN PHARMD
Provider Business Mailing Address
First Line : 887 E SAN PEDRO ST
Second Line :
City : MERIDIAN
State : ID
Zip : 83646-5650
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1400 W CHINDEN BLVD
Second Line :
City : MERIDIAN
State : ID
Zip : 83646-5328
Country : US
Telephone Number : 208-893-6033
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2009
Last Update Date : 12/21/2012

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Directions to “ TERRY LEUENHAGEN PHARMD” Practice Location

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