Provider Demographics
NPI:1821646670
Name:LECKIE, EVA SUSANNE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EVA
Middle Name:SUSANNE
Last Name:LECKIE
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 1:967 DUMPLIN VALLEY RD E
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-4406
Mailing Address - Country:US
Mailing Address - Phone:303-514-8876
Mailing Address - Fax:423-587-4091
Practice Address - Street 1:3606 W ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3603
Practice Address - Country:US
Practice Address - Phone:423-587-4107
Practice Address - Fax:423-587-4091
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000038378183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist