Provider Demographics
NPI:1649042821
Name:LEAVITT, AARON LOUIS (PHARMD, MBA)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:LOUIS
Last Name:LEAVITT
Suffix:
Gender:M
Credentials:PHARMD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 STONY BROOK DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-1516
Mailing Address - Country:US
Mailing Address - Phone:360-441-6031
Mailing Address - Fax:
Practice Address - Street 1:3706 DIANN MARIE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-3818
Practice Address - Country:US
Practice Address - Phone:502-326-9166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY023915183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist