Provider Demographics
NPI:1699302786
Name:EDENFIELD, LEAH BETHANY (PHARMD, BCOP, CPP)
Entity type:Individual
Prefix:DR
First Name:LEAH
Middle Name:BETHANY
Last Name:EDENFIELD
Suffix:
Gender:F
Credentials:PHARMD, BCOP, CPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 CREEKSHIRE WAY APT 220
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3096
Mailing Address - Country:US
Mailing Address - Phone:757-651-3344
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL CENTER BOULEVARD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-713-9867
Practice Address - Fax:336-713-9858
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25391183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist