Provider Demographics
NPI:1255626883
Name:LEAHY, EDWARD JOSEPH (RPH)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:JOSEPH
Last Name:LEAHY
Suffix:
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 1:385 CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02351-2209
Mailing Address - Country:US
Mailing Address - Phone:781-347-9004
Mailing Address - Fax:781-347-9004
Practice Address - Street 1:385 CENTRE AVE
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:MA
Practice Address - Zip Code:02351-2209
Practice Address - Country:US
Practice Address - Phone:781-347-9004
Practice Address - Fax:781-347-9004
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-11
Last Update Date:2011-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH24078183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0407534Medicaid
1427130897OtherNPI