Healthcare Provider Details

I. General information

NPI: 1427706449
Provider Name (Legal Business Name): EMILY GRACE LELAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2022
Last Update Date: 10/16/2022
Certification Date: 10/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 W TEHACHAPI BLVD
TEHACHAPI CA
93561-2559
US

IV. Provider business mailing address

1101 W TEHACHAPI BLVD
TEHACHAPI CA
93561-2559
US

V. Phone/Fax

Practice location:
  • Phone: 661-823-0163
  • Fax:
Mailing address:
  • Phone: 661-823-0163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number85917
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: