Provider Demographics
NPI:1326103722
Name:ANTHONY, LEON E III (RPH)
Entity Type:Individual
Prefix:MR
First Name:LEON
Middle Name:E
Last Name:ANTHONY
Suffix:III
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 1:707 WOODBINE DR
Mailing Address - Street 2:
Mailing Address - City:SANDERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31082-8526
Mailing Address - Country:US
Mailing Address - Phone:478-552-5429
Mailing Address - Fax:478-552-6119
Practice Address - Street 1:528 SPARTA RD
Practice Address - Street 2:
Practice Address - City:SANDERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31082-1859
Practice Address - Country:US
Practice Address - Phone:478-552-6114
Practice Address - Fax:478-552-6119
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH011573183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist