Provider Demographics
NPI:1316558000
Name:LEACH, MANDY LADENE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:LADENE
Last Name:LEACH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 HIGHWAY 278 E
Mailing Address - Street 2:
Mailing Address - City:AMORY
Mailing Address - State:MS
Mailing Address - Zip Code:38821-5304
Mailing Address - Country:US
Mailing Address - Phone:662-256-9603
Mailing Address - Fax:662-256-8495
Practice Address - Street 1:805 HIGHWAY 278 E
Practice Address - Street 2:
Practice Address - City:AMORY
Practice Address - State:MS
Practice Address - Zip Code:38821-5304
Practice Address - Country:US
Practice Address - Phone:662-256-9603
Practice Address - Fax:662-256-8495
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-11971183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist