Provider Demographics
NPI:1326473224
Name:MADRID, LEEANN (PHARMD)
Entity Type:Individual
Prefix:
First Name:LEEANN
Middle Name:
Last Name:MADRID
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 1:2618 W 15250 S
Mailing Address - Street 2:
Mailing Address - City:BLUFFDALE
Mailing Address - State:UT
Mailing Address - Zip Code:84065-5079
Mailing Address - Country:US
Mailing Address - Phone:801-971-3402
Mailing Address - Fax:
Practice Address - Street 1:2618 W 15250 S
Practice Address - Street 2:
Practice Address - City:BLUFFDALE
Practice Address - State:UT
Practice Address - Zip Code:84065-5079
Practice Address - Country:US
Practice Address - Phone:801-971-3402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6125201-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist