MEDICARE: MR. EDWARD GAETON LEAKE R.PH.

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	18783	NC

General Provider Information

NPI Number	:	1518128677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDWARD GAETON LEAKE R.PH.

Provider Business Mailing Address
First Line	:	300 MARKET ST STE 114
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27516-4493
Country	:	US
Telephone Number	:	919-240-4084
Fax Number	:	919-724-4568

Provider Business Practice Location Address
First Line	:	300 MARKET ST STE 114
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27516-4493
Country	:	US
Telephone Number	:	919-240-4084
Fax Number	:	919-724-4568

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

Provider Enumeration Date	:	06/21/2008
Last Update Date	:	10/29/2024

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