Provider Demographics
NPI:1568057032
Name:LEADY, MICHELLE AMY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:AMY
Last Name:LEADY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50631 BIRKDALE CT
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-6640
Mailing Address - Country:US
Mailing Address - Phone:574-217-2067
Mailing Address - Fax:
Practice Address - Street 1:50631 BIRKDALE CT
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-6640
Practice Address - Country:US
Practice Address - Phone:574-217-2067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26022326A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist