Provider Demographics
NPI:1548592884
Name:LEY, DAVID GEORGE
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:GEORGE
Last Name:LEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 BELL AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53027-1976
Mailing Address - Country:US
Mailing Address - Phone:262-673-7339
Mailing Address - Fax:
Practice Address - Street 1:1275 BELL AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:WI
Practice Address - Zip Code:53027-1976
Practice Address - Country:US
Practice Address - Phone:262-673-7339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9575183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist