Provider Demographics
NPI:1245819655
Name:LEAP INDUSTRIES LLC
Entity type:Organization
Organization Name:LEAP INDUSTRIES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MUZZALL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:931-206-2975
Mailing Address - Street 1:6509 HIGHWAY 41A
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VIEW
Mailing Address - State:TN
Mailing Address - Zip Code:37146-7170
Mailing Address - Country:US
Mailing Address - Phone:615-247-8602
Mailing Address - Fax:615-247-8616
Practice Address - Street 1:6509 HIGHWAY 41A STE B
Practice Address - Street 2:
Practice Address - City:PLEASANT VIEW
Practice Address - State:TN
Practice Address - Zip Code:37146-7171
Practice Address - Country:US
Practice Address - Phone:615-247-8602
Practice Address - Fax:615-247-8616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-04
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy