MEDICARE: NANCY LEACH 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	PH232392	MA

General Provider Information

NPI Number	:	1649570557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY LEACH PHARMD

Provider Business Mailing Address
First Line	:	711 MAIN ST
Second Line	:
City	:	DENNIS PORT
State	:	MA
Zip	:	02639-1420
Country	:	US
Telephone Number	:	508-398-5097
Fax Number	:

Provider Business Practice Location Address
First Line	:	711 MAIN ST
Second Line	:
City	:	DENNIS PORT
State	:	MA
Zip	:	02639-1420
Country	:	US
Telephone Number	:	508-398-5097
Fax Number	:

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

Provider Enumeration Date	:	10/25/2010
Last Update Date	:	10/25/2010

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Directions to “ NANCY LEACH PHARMD” Practice Location

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