Provider Demographics
NPI:1548863954
Name:WEDEGARTNER, LEIGHANN HEDT (RPH)
Entity type:Individual
Prefix:
First Name:LEIGHANN
Middle Name:HEDT
Last Name:WEDEGARTNER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3408 CUNNINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:WALLIS
Mailing Address - State:TX
Mailing Address - Zip Code:77485-9094
Mailing Address - Country:US
Mailing Address - Phone:281-682-0302
Mailing Address - Fax:
Practice Address - Street 1:310 OVERCREEK WAY
Practice Address - Street 2:
Practice Address - City:SEALY
Practice Address - State:TX
Practice Address - Zip Code:77474-3799
Practice Address - Country:US
Practice Address - Phone:979-627-0102
Practice Address - Fax:979-627-0102
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34057183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist