Provider Demographics
NPI:1619380391
Name:RAINWATER, LEANN (PHARMD)
Entity Type:Individual
Prefix:
First Name:LEANN
Middle Name:
Last Name:RAINWATER
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:PO BOX 1085
Mailing Address - Street 2:
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953-1085
Mailing Address - Country:US
Mailing Address - Phone:479-243-8778
Mailing Address - Fax:
Practice Address - Street 1:1359 W 2ND ST
Practice Address - Street 2:
Practice Address - City:WALDRON
Practice Address - State:AR
Practice Address - Zip Code:72958-7454
Practice Address - Country:US
Practice Address - Phone:479-637-1186
Practice Address - Fax:479-637-0921
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD11389183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist