Provider Demographics
NPI:1609186766
Name:BREWER, LEIGH ANN
Entity type:Individual
Prefix:MRS
First Name:LEIGH
Middle Name:ANN
Last Name:BREWER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 STERLING LN
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-9056
Mailing Address - Country:US
Mailing Address - Phone:870-404-8038
Mailing Address - Fax:
Practice Address - Street 1:14558 US 412
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72740-8597
Practice Address - Country:US
Practice Address - Phone:479-351-0973
Practice Address - Fax:479-351-0974
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD09601183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist