Provider Demographics
NPI:1326305467
Name:ALTMAN, LEONE RAE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LEONE
Middle Name:RAE
Last Name:ALTMAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 S INNER DR
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-2665
Mailing Address - Country:US
Mailing Address - Phone:218-263-6530
Mailing Address - Fax:
Practice Address - Street 1:505 S INNER DR
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-2665
Practice Address - Country:US
Practice Address - Phone:218-263-6530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN109293183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist