Provider Demographics
NPI:1881125623
Name:ANGELL, LEIGH (PHARMACIST)
Entity type:Individual
Prefix:
First Name:LEIGH
Middle Name:
Last Name:ANGELL
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUGOTON
Mailing Address - State:KS
Mailing Address - Zip Code:67951-2432
Mailing Address - Country:US
Mailing Address - Phone:620-544-4065
Mailing Address - Fax:620-544-7116
Practice Address - Street 1:531 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HUGOTON
Practice Address - State:KS
Practice Address - Zip Code:67951-2432
Practice Address - Country:US
Practice Address - Phone:620-544-4065
Practice Address - Fax:620-544-7116
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-12362183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201108960AMedicaid