Provider Demographics
NPI:1073145413
Name:LEITER, MADELINE ROSE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:ROSE
Last Name:LEITER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3222 U ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68503-3253
Mailing Address - Country:US
Mailing Address - Phone:402-770-0750
Mailing Address - Fax:
Practice Address - Street 1:7045 O ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2426
Practice Address - Country:US
Practice Address - Phone:402-484-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE16560183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist