Provider Demographics
NPI:1063994002
Name:MAGNUSON, LEEANN ELISABETH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LEEANN
Middle Name:ELISABETH
Last Name:MAGNUSON
Suffix:
Gender:F
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:PO BOX 212
Mailing Address - Street 2:
Mailing Address - City:CAMPOBELLO
Mailing Address - State:SC
Mailing Address - Zip Code:29322-0212
Mailing Address - Country:US
Mailing Address - Phone:864-345-4923
Mailing Address - Fax:
Practice Address - Street 1:2000 S PINE ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-3315
Practice Address - Country:US
Practice Address - Phone:864-542-1426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37862183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist