Provider Demographics
NPI:1699062075
Name:LEINBERGER, DELLA (RPH)
Entity type:Individual
Prefix:
First Name:DELLA
Middle Name:
Last Name:LEINBERGER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 E. RIVER ST.
Mailing Address - Street 2:
Mailing Address - City:CHANDLERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62627
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:140 E RIVER ST
Practice Address - Street 2:
Practice Address - City:CHANDLERVILLE
Practice Address - State:IL
Practice Address - Zip Code:62627-7031
Practice Address - Country:US
Practice Address - Phone:217-458-2294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-288349183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist