Healthcare Provider Details

I. General information

NPI: 1407254386
Provider Name (Legal Business Name): LEIA HARRISON PH.C., PHARM.D., RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2014
Last Update Date: 09/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 SAINT MICHAELS DR
SANTA FE NM
87505-7601
US

IV. Provider business mailing address

104 LEGION DR ALTA VISTA REGIONAL HOSPITAL PHARMACY
LAS VEGAS NM
87701-4804
US

V. Phone/Fax

Practice location:
  • Phone: 505-913-5287
  • Fax:
Mailing address:
  • Phone: 505-426-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR49908
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00008230
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPC00000302
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: