Healthcare Provider Details

I. General information

NPI: 1447611983
Provider Name (Legal Business Name): MICHAELA ELIZABETH LEFFLER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2016
Last Update Date: 03/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 MACCORKLE AVE SE
CHARLESTON WV
25304-1210
US

IV. Provider business mailing address

3110 MACCORKLE AVE SE
CHARLESTON WV
25304-1210
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-9948
  • Fax: 304-388-9949
Mailing address:
  • Phone: 304-388-9948
  • Fax: 304-388-9949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberRP0008479
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRP0008479
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: