MEDICARE: LEIA HARRISON PH.C., PHARM.D., RN

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	RP00008230	NM
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	PC00000302	NM
3	163W00000X	Registered Nurse	R49908	NM

General Provider Information

NPI Number	:	1407254386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEIA HARRISON PH.C., PHARM.D., RN

Provider Business Mailing Address
First Line	:	465 SAINT MICHAELS DR STE 114
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-7621
Country	:	US
Telephone Number	:	505-913-5287
Fax Number	:	505-913-4949

Provider Business Practice Location Address
First Line	:	465 SAINT MICHAELS DR
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-7670
Country	:	US
Telephone Number	:	505-913-5287
Fax Number	:	505-913-4949

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

Provider Enumeration Date	:	12/09/2014
Last Update Date	:	06/01/2026

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