MEDICARE: LEONARD FITZGERALD RPH

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	131956-1701	UT

General Provider Information

NPI Number	:	1932118981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONARD FITZGERALD RPH

Provider Business Mailing Address
First Line	:	PO BOX 716
Second Line	:
City	:	GUNNISON
State	:	UT
Zip	:	84634-0716
Country	:	US
Telephone Number	:	435-528-7555
Fax Number	:	435-528-7553

Provider Business Practice Location Address
First Line	:	520 S. MAIN
Second Line	:
City	:	GUNNISON
State	:	UT
Zip	:	84634
Country	:	US
Telephone Number	:	435-528-7555
Fax Number	:	435-528-7553

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

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	07/08/2007

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Directions to “ LEONARD FITZGERALD RPH” Practice Location

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