Provider Demographics
NPI:1548894702
Name:LEINEN, GREG (PHARMD)
Entity type:Individual
Prefix:
First Name:GREG
Middle Name:
Last Name:LEINEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:IA
Mailing Address - Zip Code:51455-1532
Mailing Address - Country:US
Mailing Address - Phone:712-269-1463
Mailing Address - Fax:712-755-3040
Practice Address - Street 1:2003 CHATBURN AVE
Practice Address - Street 2:
Practice Address - City:HARLAN
Practice Address - State:IA
Practice Address - Zip Code:51537-1845
Practice Address - Country:US
Practice Address - Phone:712-755-2525
Practice Address - Fax:712-755-3040
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21280183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist