Provider Demographics
NPI:1205956513
Name:LEONARD'S PHARMACY, INC.
Entity type:Organization
Organization Name:LEONARD'S PHARMACY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:CORSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:432-263-7377
Mailing Address - Street 1:701 SCURRY ST
Mailing Address - Street 2:P. O. BOX 671
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-2722
Mailing Address - Country:US
Mailing Address - Phone:432-263-7344
Mailing Address - Fax:432-263-0106
Practice Address - Street 1:701 SCURRY ST
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-2722
Practice Address - Country:US
Practice Address - Phone:432-263-7344
Practice Address - Fax:432-263-0106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00959332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX15567301Medicaid
TX15567301Medicaid