Provider Demographics
NPI:1164431813
Name:FURGASON, LEIGH B (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:LEIGH
Middle Name:B
Last Name:FURGASON
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6446 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PENTWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49449-9561
Mailing Address - Country:US
Mailing Address - Phone:231-869-2042
Mailing Address - Fax:
Practice Address - Street 1:39 S STATE ST
Practice Address - Street 2:
Practice Address - City:HART
Practice Address - State:MI
Practice Address - Zip Code:49420-1122
Practice Address - Country:US
Practice Address - Phone:231-873-2540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302020264183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist