Provider Demographics
NPI:1871808204
Name:INGRAM, LEAH NICOLE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LEAH
Middle Name:NICOLE
Last Name:INGRAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 BRIARWOOD CT
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37166-8408
Mailing Address - Country:US
Mailing Address - Phone:615-597-4185
Mailing Address - Fax:615-597-8394
Practice Address - Street 1:400 W PUBLIC SQ
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37166-1421
Practice Address - Country:US
Practice Address - Phone:615-597-4185
Practice Address - Fax:615-597-8394
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10443183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist