MEDICARE: DR. LEAH M GOERES PHARM D.

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	PI-0010670	OR

General Provider Information

NPI Number	:	1487938056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEAH M GOERES PHARM D.

Provider Business Mailing Address
First Line	:	2292 SW VERMONT ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97219-9431
Country	:	US
Telephone Number	:	541-591-2989
Fax Number	:

Provider Business Practice Location Address
First Line	:	2740 S 6TH ST
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97603-4604
Country	:	US
Telephone Number	:	541-273-3515
Fax Number	:

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

Provider Enumeration Date	:	09/30/2011
Last Update Date	:	09/30/2011

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