Individual
TERRY LEUENHAGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
1400 W CHINDEN BLVD, MERIDIAN, ID 83646-5328
(208) 893-6033
Mailing address
887 E SAN PEDRO ST, MERIDIAN, ID 83646-5650
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P6290
ID
Other
Enumeration date
09/12/2009
Last updated
12/21/2012
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