Provider Demographics
NPI:1942722996
Name:BARTOS, LEONARD WAYNE (RPH)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:WAYNE
Last Name:BARTOS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 OAK CREEK DR
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-5310
Mailing Address - Country:US
Mailing Address - Phone:972-938-1258
Mailing Address - Fax:
Practice Address - Street 1:800 N HIGHWAY 77
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-1884
Practice Address - Country:US
Practice Address - Phone:972-923-2297
Practice Address - Fax:972-923-2806
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-12
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22110183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist