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NPI Code Detail

MEDICARE: LEESBURG PHARMACY INC

MEDICARE: LEESBURG PHARMACY INC
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
13336C0003XCommunity/Retail Pharmacy0201000662VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14802193OTHERNCPDP PROVIDER IDENTIFICATION NUMBER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1770682601
Entity Type Code : Organization
Provider Name (Legal Business Name) : LEESBURG PHARMACY INC
Provider Business Mailing Address
First Line : PO BOX 250
Second Line :
City : THE PLAINS
State : VA
Zip : 20198-0250
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6485 MAIN STREET
Second Line :
City : THE PLAINS
State : VA
Zip : 20198
Country : US
Telephone Number : 540-253-5275
Fax Number : 540-253-5038
Authorized Official
Title or Position : PHARMACIST
Name : JAY GIL
Credential :
Telephone Number : 703-777-5333
Provider Enumeration Date : 09/21/2006
Last Update Date : 11/17/2008

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Directions to “LEESBURG PHARMACY INC ” Practice Location

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