Provider Demographics
NPI:1568800472
Name:PROCTOR, LEAH ANN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LEAH
Middle Name:ANN
Last Name:PROCTOR
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 1:3480 KILDAIRE FARM RD
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-1541
Mailing Address - Country:US
Mailing Address - Phone:919-303-4028
Mailing Address - Fax:919-267-1322
Practice Address - Street 1:3480 KILDAIRE FARM RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-1541
Practice Address - Country:US
Practice Address - Phone:919-303-4028
Practice Address - Fax:919-267-1322
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2016-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23231183500000X
FLPS52409183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist