Provider Demographics
NPI:1942526827
Name:LECKBEE, GRETTA HOPE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:GRETTA
Middle Name:HOPE
Last Name:LECKBEE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:GRETTA
Other - Middle Name:HOPE
Other - Last Name:SHULTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11521 N FM 620
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78726-1139
Mailing Address - Country:US
Mailing Address - Phone:512-249-0577
Mailing Address - Fax:512-249-0707
Practice Address - Street 1:11521 N FM 620
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78726-1139
Practice Address - Country:US
Practice Address - Phone:512-249-0577
Practice Address - Fax:512-249-0707
Is Sole Proprietor?:No
Enumeration Date:2010-04-16
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37650183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist