Provider Demographics
NPI:1396811857
Name:LEVERITT, SAMUEL EDWARD (PHARMD, BCNP)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:EDWARD
Last Name:LEVERITT
Suffix:
Gender:M
Credentials:PHARMD, BCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 E BAYSHORE DR
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-4247
Mailing Address - Country:US
Mailing Address - Phone:417-300-4090
Mailing Address - Fax:417-831-5517
Practice Address - Street 1:3040 E ELM ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-2632
Practice Address - Country:US
Practice Address - Phone:417-831-5190
Practice Address - Fax:417-831-5517
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001024195183500000X, 1835N0905X
AR007349183500000X, 1835N0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N0905XPharmacy Service ProvidersPharmacistNuclear
No183500000XPharmacy Service ProvidersPharmacist