MEDICARE: CURTIS LEIDER

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	18436-40	WI

General Provider Information

NPI Number	:	1982056362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CURTIS LEIDER

Provider Business Mailing Address
First Line	:	109 DOTY ST
Second Line	:
City	:	FREMONT
State	:	WI
Zip	:	54940-9104
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	291 S MAIN ST
Second Line	:
City	:	CLINTONVILLE
State	:	WI
Zip	:	54929-1604
Country	:	US
Telephone Number	:	715-823-2350
Fax Number	:

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

Provider Enumeration Date	:	07/08/2016
Last Update Date	:	07/08/2016

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Directions to “ CURTIS LEIDER ” Practice Location

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