Healthcare Provider Details

I. General information

NPI: 1881478659
Provider Name (Legal Business Name): LEANDRA DANG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEANDRA MIKO PHARMD

II. Dates (important events)

Enumeration Date: 08/23/2023
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1468 MADISON AVE
NEW YORK NY
10029-6508
US

IV. Provider business mailing address

1641 3RD AVE APT 31G
NEW YORK NY
10128-3633
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-6500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number052701
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1835S0206X
TaxonomySolid Organ Transplant Pharmacist
License Number052701
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: