Provider Demographics
NPI:1841810579
Name:MOONEY, LEAH (PHARMD)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:MOONEY
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 1:410 N LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-2636
Mailing Address - Country:US
Mailing Address - Phone:309-846-9675
Mailing Address - Fax:
Practice Address - Street 1:825 MALERICH DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:IL
Practice Address - Zip Code:62656-9700
Practice Address - Country:US
Practice Address - Phone:217-735-3344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.302516183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist