Provider Demographics
NPI:1265037568
Name:SHETLER, LEONARD
Entity type:Individual
Prefix:
First Name:LEONARD
Middle Name:
Last Name:SHETLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57271 COUNTY ROAD 23
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46528-7097
Mailing Address - Country:US
Mailing Address - Phone:574-536-6260
Mailing Address - Fax:
Practice Address - Street 1:CVS PHARMACY
Practice Address - Street 2:975 N 00 EW
Practice Address - City:LAGRANGE
Practice Address - State:IN
Practice Address - Zip Code:46761-4676
Practice Address - Country:US
Practice Address - Phone:260-463-2583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26016450A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist