Provider Demographics
NPI:1205120268
Name:LEEDHAM, ROBERT KENNINGTON JR (RPH)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:KENNINGTON
Last Name:LEEDHAM
Suffix:JR
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 1:777 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-2222
Mailing Address - Country:US
Mailing Address - Phone:608-262-4723
Mailing Address - Fax:608-262-5262
Practice Address - Street 1:777 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2222
Practice Address - Country:US
Practice Address - Phone:608-262-4723
Practice Address - Fax:608-262-5262
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE - 06676183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist