Provider Demographics
NPI:1760974604
Name:LEAMON, CASEY LYNN (PHARMD)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:LYNN
Last Name:LEAMON
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 1:308 EVERGREEN ST
Mailing Address - Street 2:
Mailing Address - City:CHURCH HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37642-4215
Mailing Address - Country:US
Mailing Address - Phone:423-306-6393
Mailing Address - Fax:
Practice Address - Street 1:102 E BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-2323
Practice Address - Country:US
Practice Address - Phone:423-623-0364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN42065183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist