Leigh Ford Bruner, PHARM. D.
Individual provider Active NPI Pharmacist · Blakely, GA
NPI 1437337151 · NPPES record last updated Feb 5, 2008
Key facts
- NPI
- 1437337151
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 020815 (GA)
- Practice address
- 90 Court SQ
Blakely, GA 39823-2340 - Phone
- (229) 723-3441
- Fax
- (229) 723-8707
- NPI assigned
- Feb 5, 2008
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 020815 | GA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Blakely Pharmacy LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 020815 | GA | Yes |
Addresses
Primary practice location
90 Court SQ
Blakely, GA 39823-2340
Mailing address
1330 Indian Mounds Rd
Blakely, GA 39823-4407
Phone (229) 724-2190
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 020815 | Other | GA | GA PHARMACIST LICENSE |
Other providers in Blakely, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 5, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.