Provider Demographics
NPI:1124166798
Name:LEECH, GEORGIA ANN (PHARMACIST RPH)
Entity type:Individual
Prefix:MS
First Name:GEORGIA
Middle Name:ANN
Last Name:LEECH
Suffix:
Gender:F
Credentials:PHARMACIST RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 LILLIAN MILLER PARKWAY
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210
Mailing Address - Country:US
Mailing Address - Phone:940-382-1618
Mailing Address - Fax:
Practice Address - Street 1:2500 LILLIAN MILLER PKWY
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-2902
Practice Address - Country:US
Practice Address - Phone:940-382-1618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-03
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16061183500000X
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist