Provider Demographics
NPI:1639456924
Name:MONTGOMERY, LEIGH ANN (PHARMACIST)
Entity Type:Individual
Prefix:MS
First Name:LEIGH
Middle Name:ANN
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2026 HIGHWAY 72 E
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-6709
Mailing Address - Country:US
Mailing Address - Phone:662-287-4066
Mailing Address - Fax:662-287-5783
Practice Address - Street 1:2026 HIGHWAY 72 E
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-6709
Practice Address - Country:US
Practice Address - Phone:662-287-4066
Practice Address - Fax:662-287-5783
Is Sole Proprietor?:No
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-8730183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MST-8730OtherPHARMACIST LISC NUMBER