Provider Demographics
NPI:1750730941
Name:LEADER, LAUREN DENISE (PHARMD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:DENISE
Last Name:LEADER
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 1:10706 LANTERN RD
Mailing Address - Street 2:APT 2201
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-3119
Mailing Address - Country:US
Mailing Address - Phone:586-295-8496
Mailing Address - Fax:
Practice Address - Street 1:4588 PARKVIEW PL
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1029
Practice Address - Country:US
Practice Address - Phone:586-295-8496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20160144091835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care