Provider Demographics
NPI:1417098989
Name:PIECHOCKI, LEANN
Entity Type:Individual
Prefix:MRS
First Name:LEANN
Middle Name:
Last Name:PIECHOCKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16333 HAVERHILL DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-1952
Mailing Address - Country:US
Mailing Address - Phone:586-532-0188
Mailing Address - Fax:
Practice Address - Street 1:46591 ROMEO PLANK RD
Practice Address - Street 2:SUITE 125
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-5742
Practice Address - Country:US
Practice Address - Phone:586-226-6060
Practice Address - Fax:586-226-6061
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027550183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist