MEDICARE: LEIGHA MARIE CURTISS PHARM D/ RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	13394	NE
2	183500000X	Pharmacist	SO18253	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	108397569	OTHER	AZ	NDPCP

General Provider Information

NPI Number	:	1093017246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEIGHA MARIE CURTISS PHARM D/ RPH

Provider Business Mailing Address
First Line	:	PO BOX 1861
Second Line	:
City	:	FORT DEFIANCE
State	:	AZ
Zip	:	86504-1861
Country	:	US
Telephone Number	:	402-578-1822
Fax Number	:	928-729-8348

Provider Business Practice Location Address
First Line	:	7 ROUTE 12
Second Line	:
City	:	FORT DEFIANCE
State	:	AZ
Zip	:	86504-2325
Country	:	US
Telephone Number	:	928-729-8345
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2010
Last Update Date	:	10/21/2011

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Directions to “ LEIGHA MARIE CURTISS PHARM D/ RPH” Practice Location

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