Provider Demographics
NPI:1306121280
Name:LEINBACH, EDMUND ALAN (PHARMD)
Entity type:Individual
Prefix:MR
First Name:EDMUND
Middle Name:ALAN
Last Name:LEINBACH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9240 ROCKVILLE RD
Mailing Address - Street 2:WALGREENS #7031
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234
Mailing Address - Country:US
Mailing Address - Phone:317-209-1047
Mailing Address - Fax:
Practice Address - Street 1:9240 ROCKVILLE RD
Practice Address - Street 2:WALGREENS #7031
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46234
Practice Address - Country:US
Practice Address - Phone:317-209-1047
Practice Address - Fax:317-209-1058
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021258A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist