Provider Demographics
NPI:1376839084
Name:LEOPOLD, LETTIE E (RPH)
Entity Type:Individual
Prefix:
First Name:LETTIE
Middle Name:E
Last Name:LEOPOLD
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 1:5375 N SOCRUM LOOP RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-4272
Mailing Address - Country:US
Mailing Address - Phone:863-370-0943
Mailing Address - Fax:
Practice Address - Street 1:5375 N SOCRUM LOOP RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-4272
Practice Address - Country:US
Practice Address - Phone:863-859-6353
Practice Address - Fax:863-859-3524
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS44257183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist