Provider Demographics
NPI:1093298135
Name:LEONARD, LINDA CLEO (RPH)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:CLEO
Last Name:LEONARD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:TN
Mailing Address - Zip Code:37185-1510
Mailing Address - Country:US
Mailing Address - Phone:931-296-3703
Mailing Address - Fax:931-296-3593
Practice Address - Street 1:211 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:TN
Practice Address - Zip Code:37185-1510
Practice Address - Country:US
Practice Address - Phone:931-296-3703
Practice Address - Fax:931-296-3593
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4992183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist