Provider Demographics
NPI:1649818576
Name:LEAVELL, BAYLEA ANN (PHARMD)
Entity type:Individual
Prefix:
First Name:BAYLEA
Middle Name:ANN
Last Name:LEAVELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 SOLOGNE FOREST DR
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-7094
Mailing Address - Country:US
Mailing Address - Phone:479-970-0761
Mailing Address - Fax:
Practice Address - Street 1:10300 N RODNEY PARHAM RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72227-4845
Practice Address - Country:US
Practice Address - Phone:501-221-8301
Practice Address - Fax:501-221-8303
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD12763183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist