Provider Demographics
NPI:1013083716
Name:LEADBETTER, COLLEEN RENAE (PHARMD)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:RENAE
Last Name:LEADBETTER
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 1:4711 SCOTT ALLEN DRIVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-2784
Mailing Address - Country:US
Mailing Address - Phone:406-728-8848
Mailing Address - Fax:406-728-4290
Practice Address - Street 1:4711 SCOTT ALLEN DR
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59803-2784
Practice Address - Country:US
Practice Address - Phone:406-728-8848
Practice Address - Fax:406-728-4290
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA20252183500000X
MT3671183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist