Provider Demographics
NPI:1245532035
Name:BOARDWINE, LEAH MICHELE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LEAH
Middle Name:MICHELE
Last Name:BOARDWINE
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 1:4488 ELECTRIC RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-0722
Mailing Address - Country:US
Mailing Address - Phone:540-989-4448
Mailing Address - Fax:540-776-1460
Practice Address - Street 1:4488 ELECTRIC RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-0722
Practice Address - Country:US
Practice Address - Phone:540-989-4448
Practice Address - Fax:540-776-1460
Is Sole Proprietor?:No
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202209377183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist