Provider Demographics
NPI:1427337005
Name:LEONARD, CRAIG (RPH)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:LEONARD
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 1:14 ANCHOR DR
Mailing Address - Street 2:
Mailing Address - City:LAKE TAPAWINGO
Mailing Address - State:MO
Mailing Address - Zip Code:64015-9695
Mailing Address - Country:US
Mailing Address - Phone:816-229-5204
Mailing Address - Fax:
Practice Address - Street 1:14 ANCHOR DR
Practice Address - Street 2:
Practice Address - City:LAKE TAPAWINGO
Practice Address - State:MO
Practice Address - Zip Code:64015-9695
Practice Address - Country:US
Practice Address - Phone:816-229-5204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO028568183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist