Provider Demographics
NPI:1245259522
Name:LEACH, KEVIN C (RPH)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:C
Last Name:LEACH
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 1:97 GREENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-0373
Mailing Address - Country:US
Mailing Address - Phone:406-443-8724
Mailing Address - Fax:
Practice Address - Street 1:1500 WILLIAMS STREET
Practice Address - Street 2:
Practice Address - City:FT. HARRISON
Practice Address - State:MT
Practice Address - Zip Code:59636
Practice Address - Country:US
Practice Address - Phone:406-447-7571
Practice Address - Fax:406-447-7569
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3262183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist