Provider Demographics
NPI:1518128677
Name:LEAKE, EDWARD GAETON (RPH)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:GAETON
Last Name:LEAKE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:300 MARKET ST STE 114
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-4493
Mailing Address - Country:US
Mailing Address - Phone:919-240-4084
Mailing Address - Fax:919-724-4568
Practice Address - Street 1:300 MARKET ST STE 114
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-4493
Practice Address - Country:US
Practice Address - Phone:919-240-4084
Practice Address - Fax:919-724-4568
Is Sole Proprietor?:No
Enumeration Date:2008-06-21
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18783183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist