Provider Demographics
NPI:1982941886
Name:WIRTH, LEIGH P (PHARM D)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:P
Last Name:WIRTH
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 S US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32962-4703
Mailing Address - Country:US
Mailing Address - Phone:772-778-7933
Mailing Address - Fax:772-778-0057
Practice Address - Street 1:810 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32962-4703
Practice Address - Country:US
Practice Address - Phone:772-778-7933
Practice Address - Fax:772-778-0057
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40210183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist