Provider Demographics
NPI:1316220726
Name:PETROUSKE, LEANNE (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:LEANNE
Middle Name:
Last Name:PETROUSKE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21324 SAINT ANDREWS BLVD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-2432
Mailing Address - Country:US
Mailing Address - Phone:561-368-5759
Mailing Address - Fax:
Practice Address - Street 1:21324 SAINT ANDREWS BLVD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-2432
Practice Address - Country:US
Practice Address - Phone:561-368-5759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0032648183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist