Provider Demographics
NPI:1023259686
Name:LEUZINGER, WALTER Y (RPH)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:Y
Last Name:LEUZINGER
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 1:6149 CR 622F
Mailing Address - Street 2:
Mailing Address - City:BUSHNELL
Mailing Address - State:FL
Mailing Address - Zip Code:33513-7996
Mailing Address - Country:US
Mailing Address - Phone:352-793-3754
Mailing Address - Fax:
Practice Address - Street 1:1103 W NORTH BLVD
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-3949
Practice Address - Country:US
Practice Address - Phone:352-787-0593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0018426183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist