Provider Demographics
NPI:1447540745
Name:LEATHERWOOD, JERRERD TAYLOR (RPH)
Entity type:Individual
Prefix:MR
First Name:JERRERD
Middle Name:TAYLOR
Last Name:LEATHERWOOD
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 1:555 SPARKMAN DR NW
Mailing Address - Street 2:SUITE 814
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35816-3418
Mailing Address - Country:US
Mailing Address - Phone:256-479-1038
Mailing Address - Fax:256-417-4940
Practice Address - Street 1:555 SPARKMAN DR NW
Practice Address - Street 2:SUITE 814
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35816-3418
Practice Address - Country:US
Practice Address - Phone:256-479-1038
Practice Address - Fax:256-417-4940
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13353183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist