Provider Demographics
NPI:1972867166
Name:LEETH, SHAY DARYL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHAY
Middle Name:DARYL
Last Name:LEETH
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 1:245 DENSMORE RD
Mailing Address - Street 2:
Mailing Address - City:JOPPA
Mailing Address - State:AL
Mailing Address - Zip Code:35087-6157
Mailing Address - Country:US
Mailing Address - Phone:256-586-8307
Mailing Address - Fax:
Practice Address - Street 1:710 CENTER ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1527
Practice Address - Country:US
Practice Address - Phone:706-571-1495
Practice Address - Fax:706-571-1861
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH026564183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist