Provider Demographics
NPI:1164597050
Name:GIVENS, LEONARD RAY (RPH)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:RAY
Last Name:GIVENS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 EAGLES LANDING PKWY
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5012
Mailing Address - Country:US
Mailing Address - Phone:770-474-5005
Mailing Address - Fax:770-474-8093
Practice Address - Street 1:1090 EAGLES LANDING PKWY
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5012
Practice Address - Country:US
Practice Address - Phone:770-474-5005
Practice Address - Fax:770-474-8093
Is Sole Proprietor?:No
Enumeration Date:2006-11-23
Last Update Date:2011-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH010387183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist