Provider Demographics
NPI:1578070751
Name:SUMRALL, LELAND (PHARMD)
Entity Type:Individual
Prefix:
First Name:LELAND
Middle Name:
Last Name:SUMRALL
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 1:30304 HIGHWAY 21
Mailing Address - Street 2:
Mailing Address - City:ANGIE
Mailing Address - State:LA
Mailing Address - Zip Code:70426-4264
Mailing Address - Country:US
Mailing Address - Phone:985-986-4433
Mailing Address - Fax:985-986-4900
Practice Address - Street 1:30304 HIGHWAY 21
Practice Address - Street 2:
Practice Address - City:ANGIE
Practice Address - State:LA
Practice Address - Zip Code:70426-4264
Practice Address - Country:US
Practice Address - Phone:985-986-4433
Practice Address - Fax:985-986-4900
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17192183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist