Provider Demographics
NPI:1467702134
Name:LEECH, JONATHAN REED (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:REED
Last Name:LEECH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 S PRAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-2022
Mailing Address - Country:US
Mailing Address - Phone:719-561-4407
Mailing Address - Fax:719-561-1294
Practice Address - Street 1:1231 S PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-2022
Practice Address - Country:US
Practice Address - Phone:719-561-4407
Practice Address - Fax:719-561-1294
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2013-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP7554183500000X
CO18753183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist