Provider Demographics
NPI:1235683046
Name:LEONARD, ANTHONY SHANE (RPH)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:SHANE
Last Name:LEONARD
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 1:3885 MOUNT BEULAH RD
Mailing Address - Street 2:
Mailing Address - City:SHERRILLS FORD
Mailing Address - State:NC
Mailing Address - Zip Code:28673-7804
Mailing Address - Country:US
Mailing Address - Phone:704-483-8447
Mailing Address - Fax:
Practice Address - Street 1:2622 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-4319
Practice Address - Country:US
Practice Address - Phone:704-735-2551
Practice Address - Fax:704-735-6222
Is Sole Proprietor?:No
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12631183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist