Provider Demographics
NPI:1205181799
Name:LEASE, LEANN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LEANN
Middle Name:
Last Name:LEASE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 RANDOLPH AVE
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-3950
Mailing Address - Country:US
Mailing Address - Phone:304-636-8180
Mailing Address - Fax:304-636-8310
Practice Address - Street 1:615 RANDOLPH AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3950
Practice Address - Country:US
Practice Address - Phone:304-636-8180
Practice Address - Fax:304-636-8310
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV7897183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist