Provider Demographics
NPI:1780449975
Name:LEARY, EMILI JEANNE-WATTS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:EMILI
Middle Name:JEANNE-WATTS
Last Name:LEARY
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 1:10822 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:HEWITT
Mailing Address - State:WI
Mailing Address - Zip Code:54441-9042
Mailing Address - Country:US
Mailing Address - Phone:608-228-3250
Mailing Address - Fax:
Practice Address - Street 1:500 E VETERANS ST
Practice Address - Street 2:
Practice Address - City:TOMAH
Practice Address - State:WI
Practice Address - Zip Code:54660-3105
Practice Address - Country:US
Practice Address - Phone:608-372-3971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18437-401835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist