Provider Demographics
NPI:1104822147
Name:LEONARD'S PHARMACY, INC.
Entity Type:Organization
Organization Name:LEONARD'S PHARMACY, INC.
Other - Org Name:WESTOVER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:KANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH PHARMD
Authorized Official - Phone:432-267-1611
Mailing Address - Street 1:710 W MARCY DR
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-6581
Mailing Address - Country:US
Mailing Address - Phone:432-267-1611
Mailing Address - Fax:432-267-4237
Practice Address - Street 1:710 W MARCY DR
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-6581
Practice Address - Country:US
Practice Address - Phone:432-267-1611
Practice Address - Fax:432-267-4237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23536332B00000X
TX00166332B00000X, 333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140513Medicaid
TX013610301Medicaid
0496970001Medicare NSC