Provider Demographics
NPI:1750978979
Name:LEER, LAURIE CHUDEJ (RPH)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:CHUDEJ
Last Name:LEER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77879-0129
Mailing Address - Country:US
Mailing Address - Phone:979-596-3081
Mailing Address - Fax:
Practice Address - Street 1:16800 SH 36 SOUTH
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:TX
Practice Address - Zip Code:77879-7787
Practice Address - Country:US
Practice Address - Phone:979-596-3081
Practice Address - Fax:979-596-3083
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36276183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist