Provider Demographics
NPI:1265834758
Name:LEAMAN, JILL (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:LEAMAN
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1903 GLEN LAKES CIR N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2145
Mailing Address - Country:US
Mailing Address - Phone:352-514-5451
Mailing Address - Fax:
Practice Address - Street 1:3625 W GANDY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-2607
Practice Address - Country:US
Practice Address - Phone:813-835-9414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41374183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist