Provider Demographics
NPI:1487287819
Name:LEAVELLE, ZERLINA RUTH (CPHT)
Entity type:Individual
Prefix:MRS
First Name:ZERLINA
Middle Name:RUTH
Last Name:LEAVELLE
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 S. OKLAHOMA CUTOFF
Mailing Address - Street 2:
Mailing Address - City:BURKBURNETT
Mailing Address - State:TX
Mailing Address - Zip Code:76354
Mailing Address - Country:US
Mailing Address - Phone:940-569-5600
Mailing Address - Fax:940-569-5608
Practice Address - Street 1:514 S. OKLAHOMA CUTOFF
Practice Address - Street 2:
Practice Address - City:BURKBURNETT
Practice Address - State:TX
Practice Address - Zip Code:76354-7635
Practice Address - Country:US
Practice Address - Phone:940-569-5600
Practice Address - Fax:940-569-5608
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109858183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician