Provider Demographics
NPI:1275634156
Name:LEECH, EDWARD ANTHONY (RPH)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:ANTHONY
Last Name:LEECH
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 1:2003 PRIMROSE DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-8646
Mailing Address - Country:US
Mailing Address - Phone:815-409-1373
Mailing Address - Fax:
Practice Address - Street 1:2003 PRIMROSE DR
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60586-8646
Practice Address - Country:US
Practice Address - Phone:815-409-1373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist