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NPI Code Detail

MEDICARE: LEANN DALLAS PHARMD

MEDICARE: LEANN DALLAS 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
1183500000XPharmacistPD08324AR

General Provider Information

NPI Number : 1538108477
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEANN DALLAS PHARMD
Provider Business Mailing Address
First Line : 1006 OAKWOOD DR
Second Line :
City : WYNNE
State : AR
Zip : 72396-1802
Country : US
Telephone Number : 870-238-4465
Fax Number :
Provider Business Practice Location Address
First Line : 411 FALLS BLVD S
Second Line :
City : WYNNE
State : AR
Zip : 72396-3501
Country : US
Telephone Number : 870-238-8511
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2006
Last Update Date : 07/08/2007

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Directions to “ LEANN DALLAS PHARMD” Practice Location

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