Provider Demographics
NPI:1659867299
Name:PENDLETON, LEAH MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:MARIE
Last Name:PENDLETON
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 1:539 GRANT RD
Mailing Address - Street 2:
Mailing Address - City:BROOKS
Mailing Address - State:GA
Mailing Address - Zip Code:30205-1718
Mailing Address - Country:US
Mailing Address - Phone:770-362-4830
Mailing Address - Fax:
Practice Address - Street 1:730 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-3618
Practice Address - Country:US
Practice Address - Phone:706-648-4048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH030604183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist