Provider Demographics
NPI:1861065518
Name:LEONARD, MICHEAL THEO HOWARD (PHARMD)
Entity type:Individual
Prefix:
First Name:MICHEAL
Middle Name:THEO HOWARD
Last Name:LEONARD
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 1:3016 W 8525 S
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-9642
Mailing Address - Country:US
Mailing Address - Phone:425-652-7899
Mailing Address - Fax:208-723-3927
Practice Address - Street 1:5800 S REDWOOD RD
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123-5327
Practice Address - Country:US
Practice Address - Phone:801-565-0017
Practice Address - Fax:801-252-4949
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5824628-1721183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist