Healthcare Provider Details

I. General information

NPI: 1306442538
Provider Name (Legal Business Name): MOLLY LEISING PHARM. D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2020
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 EVANS ST
WILLIAMSVILLE NY
14221-5622
US

IV. Provider business mailing address

79 OLD STONE RD
DEPEW NY
14043-4232
US

V. Phone/Fax

Practice location:
  • Phone: 716-632-1940
  • Fax:
Mailing address:
  • Phone: 585-469-0793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number067423
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: