Provider Demographics
NPI:1063955367
Name:GRASSO, LEIGH ANN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LEIGH
Middle Name:ANN
Last Name:GRASSO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:LEIGH
Other - Middle Name:ANN
Other - Last Name:MCGONAGILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:31007 IH 10 W
Mailing Address - Street 2:STE 108
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:31007 IH 10 W
Practice Address - Street 2:STE 108
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006
Practice Address - Country:US
Practice Address - Phone:830-981-4774
Practice Address - Fax:830-981-4775
Is Sole Proprietor?:No
Enumeration Date:2016-11-18
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRPH42501183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist