Provider Demographics
NPI:1023678083
Name:PRUNTY, LEESA MARIE (PHARMD, BCPS, BCPPS)
Entity type:Individual
Prefix:
First Name:LEESA
Middle Name:MARIE
Last Name:PRUNTY
Suffix:
Gender:F
Credentials:PHARMD, BCPS, BCPPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11435 WOODIEBROOK RD
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-8472
Mailing Address - Country:US
Mailing Address - Phone:440-667-0971
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-286-8035
Practice Address - Fax:216-201-6693
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0007676183500000X
OH81505691835P0200X
OH31215481835P1200X
OH03132315183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0200XPharmacy Service ProvidersPharmacistPediatrics
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy