Healthcare Provider Details

I. General information

NPI: 1104732460
Provider Name (Legal Business Name): LEISA PHILLIPS CLEVELAND PHARMACIST (RPH)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 MAIN ST
WINDSOR LOCKS CT
06096-1913
US

IV. Provider business mailing address

70 CRABAPPLE RD
WINDSOR CT
06095-1821
US

V. Phone/Fax

Practice location:
  • Phone: 860-623-2407
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT.008094
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: