Provider Demographics
NPI:1932540309
Name:LEAKE, SAMUEL NATHAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:NATHAN
Last Name:LEAKE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 GREEN HILL DR
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-4148
Mailing Address - Country:US
Mailing Address - Phone:864-360-3697
Mailing Address - Fax:
Practice Address - Street 1:105 HEARTHSTONE DR
Practice Address - Street 2:
Practice Address - City:GRAY COURT
Practice Address - State:SC
Practice Address - Zip Code:29645
Practice Address - Country:US
Practice Address - Phone:864-360-3697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-12
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14181183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist