Healthcare Provider Details

I. General information

NPI: 1326273467
Provider Name (Legal Business Name): LORETTA N LEGER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 05/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 TRAMWAY BLVD NE
ALBUQUERQUE NM
87111-2979
US

IV. Provider business mailing address

11407 CORONADO NE
ALBUQUERQUE NM
87122
US

V. Phone/Fax

Practice location:
  • Phone: 505-292-5888
  • Fax: 505-292-7468
Mailing address:
  • Phone: 360-349-1502
  • Fax: 505-292-7468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number5199
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPH00057217
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: