Provider Demographics
NPI:1164416830
Name:LEONARDS PHARMACY INC
Entity Type:Organization
Organization Name:LEONARDS PHARMACY INC
Other - Org Name:PROFESSIONAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLELLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-267-2546
Mailing Address - Street 1:1000 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-2949
Mailing Address - Country:US
Mailing Address - Phone:432-267-2546
Mailing Address - Fax:432-267-7217
Practice Address - Street 1:1000 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-2949
Practice Address - Country:US
Practice Address - Phone:432-267-2546
Practice Address - Fax:432-267-7217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
TX12913336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2093625OtherPK
TX110255Medicaid
0496970003Medicare NSC