Provider Demographics
NPI:1376827840
Name:LEITNER, LAUREN KAY (RPH)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:KAY
Last Name:LEITNER
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 1:4122 US HIGHWAY 31 S
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49685-9228
Mailing Address - Country:US
Mailing Address - Phone:231-943-4017
Mailing Address - Fax:231-943-3586
Practice Address - Street 1:4122 US HIGHWAY 31 S
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49685-9228
Practice Address - Country:US
Practice Address - Phone:231-943-4017
Practice Address - Fax:231-943-3586
Is Sole Proprietor?:No
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302025718183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist