Provider Demographics
NPI:1295221299
Name:LEONHARDT, TYLER BENJAMIN (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:BENJAMIN
Last Name:LEONHARDT
Suffix:
Gender:M
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 1:6810 DOWNS BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40228-1321
Mailing Address - Country:US
Mailing Address - Phone:502-821-3260
Mailing Address - Fax:
Practice Address - Street 1:10201 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40272-3949
Practice Address - Country:US
Practice Address - Phone:502-933-4003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY019975183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist