Provider Demographics
NPI:1336275742
Name:LEACH, DAVID WESLEY (RPH)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WESLEY
Last Name:LEACH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 POTOMAC LN
Mailing Address - Street 2:
Mailing Address - City:STOYSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15563-9034
Mailing Address - Country:US
Mailing Address - Phone:814-754-8169
Mailing Address - Fax:814-754-4419
Practice Address - Street 1:192 POTOMAC LN
Practice Address - Street 2:
Practice Address - City:STOYSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15563-9034
Practice Address - Country:US
Practice Address - Phone:814-754-8169
Practice Address - Fax:814-754-4419
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP028333L183500000X
OH03-1-10815183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist