Jeremy I Leach, R.PH.
Individual provider Active NPI Pharmacist · Fredericktown, MO
NPI 1629417340 · NPPES record last updated Jun 15, 2013
Key facts
- NPI
- 1629417340
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 2005002685 (MO)
- Practice address
- 1025 E Highway 72 Byp
Fredericktown, MO 63645-7326 - Phone
- (573) 783-6000
- Fax
- (573) 783-6008
- NPI assigned
- Jun 15, 2013
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2005002685 | MO | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 2005002685 | MO | Yes |
Addresses
Primary practice location
1025 E Highway 72 Byp
Fredericktown, MO 63645-7326
Mailing address
1025 E Highway 72 Byp
Fredericktown, MO 63645-7326
Phone (573) 783-6000
Other providers in Fredericktown, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 15, 2013. 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.