Provider Demographics
NPI:1073720132
Name:JESSEE, LEONARD DWIGHT (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:DWIGHT
Last Name:JESSEE
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 469
Mailing Address - Street 2:
Mailing Address - City:APPALACHIA
Mailing Address - State:VA
Mailing Address - Zip Code:24216-0469
Mailing Address - Country:US
Mailing Address - Phone:276-565-3434
Mailing Address - Fax:276-565-0473
Practice Address - Street 1:205 KILBOURNE AVENUE
Practice Address - Street 2:
Practice Address - City:APPALACHIA
Practice Address - State:VA
Practice Address - Zip Code:24216
Practice Address - Country:US
Practice Address - Phone:276-565-3434
Practice Address - Fax:276-565-0473
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202011765183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist