Provider Demographics
NPI:1295464295
Name:LOVELL, LEIGH (CERTIFIED PHARMACY T)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:
Last Name:LOVELL
Suffix:
Gender:M
Credentials:CERTIFIED PHARMACY T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 CR 709
Mailing Address - Street 2:
Mailing Address - City:BLUE MOUNTAIN
Mailing Address - State:MS
Mailing Address - Zip Code:38610
Mailing Address - Country:US
Mailing Address - Phone:469-713-4776
Mailing Address - Fax:
Practice Address - Street 1:50 CR 709
Practice Address - Street 2:
Practice Address - City:BLUE MOUNTAIN
Practice Address - State:MS
Practice Address - Zip Code:38610
Practice Address - Country:US
Practice Address - Phone:469-713-4776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX129142183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician