Healthcare Provider Details

I. General information

NPI: 1659607448
Provider Name (Legal Business Name): LESLI ANNE LAVERY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LESLI ANNE FISHER PHARMD

II. Dates (important events)

Enumeration Date: 10/28/2009
Last Update Date: 08/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43112 15TH ST W INFUSION PHARMACY ROOM 1434
LANCASTER CA
93534-6219
US

IV. Provider business mailing address

43112 15TH ST W INFUSION PHARMACY ROOM 1434
LANCASTER CA
93534-6219
US

V. Phone/Fax

Practice location:
  • Phone: 661-726-2369
  • Fax: 661-726-2385
Mailing address:
  • Phone: 661-726-2369
  • Fax: 661-726-2385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302036594
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number63616
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: