Provider Demographics
NPI:1215538798
Name:CONNER, LEIGH ANNE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LEIGH
Middle Name:ANNE
Last Name:CONNER
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 1:4701 LOG CABIN DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-6318
Mailing Address - Country:US
Mailing Address - Phone:478-788-6774
Mailing Address - Fax:
Practice Address - Street 1:4701 LOG CABIN DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-6318
Practice Address - Country:US
Practice Address - Phone:478-788-6774
Practice Address - Fax:478-788-7455
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022159183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist