Provider Demographics
NPI:1508157124
Name:SMOUSE, LEANNE
Entity Type:Individual
Prefix:MRS
First Name:LEANNE
Middle Name:
Last Name:SMOUSE
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 1:108 BLUFF ST
Mailing Address - Street 2:
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-2107
Mailing Address - Country:US
Mailing Address - Phone:724-543-2265
Mailing Address - Fax:
Practice Address - Street 1:165 BUTLER RD
Practice Address - Street 2:
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-2329
Practice Address - Country:US
Practice Address - Phone:724-543-2265
Practice Address - Fax:724-548-2793
Is Sole Proprietor?:No
Enumeration Date:2011-04-30
Last Update Date:2011-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP044201L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist