Provider Demographics
NPI:1922173319
Name:LEISS, WAYNE RICHARD (RPH, PHARMD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:RICHARD
Last Name:LEISS
Suffix:
Gender:M
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 N COUNTY ROAD 25A
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-1309
Mailing Address - Country:US
Mailing Address - Phone:937-440-4262
Mailing Address - Fax:937-440-4265
Practice Address - Street 1:3130 N COUNTY ROAD 25A
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-1309
Practice Address - Country:US
Practice Address - Phone:937-440-4262
Practice Address - Fax:937-440-4265
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2023-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-26748183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist