Provider Demographics
NPI:1336742006
Name:LEANDRO, KAYLA LYNN
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:LYNN
Last Name:LEANDRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 LAWTONS LN
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:MA
Mailing Address - Zip Code:02790-4902
Mailing Address - Country:US
Mailing Address - Phone:774-201-1144
Mailing Address - Fax:
Practice Address - Street 1:548 DARTMOUTH ST
Practice Address - Street 2:
Practice Address - City:SOUTH DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02748-1908
Practice Address - Country:US
Practice Address - Phone:508-991-7934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA239021183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist