Provider Demographics
NPI:1023005956
Name:LEACH, TERRY DAVID (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:DAVID
Last Name:LEACH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 112
Mailing Address - Street 2:
Mailing Address - City:NEW KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12459-0112
Mailing Address - Country:US
Mailing Address - Phone:845-586-4969
Mailing Address - Fax:
Practice Address - Street 1:3693 THOMSON HOLLOW
Practice Address - Street 2:
Practice Address - City:NEW KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12459
Practice Address - Country:US
Practice Address - Phone:845-586-4969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-16475183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist