MEDICARE: MRS. ASHLEY MICHELLE LEIS PHARMD, RPH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03-2-28100	OH

General Provider Information

NPI Number	:	1053501064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ASHLEY MICHELLE LEIS PHARMD, RPH.

Provider Business Mailing Address
First Line	:	2028 E HARBOR RD
Second Line	:
City	:	PORT CLINTON
State	:	OH
Zip	:	43452-1511
Country	:	US
Telephone Number	:	419-732-6452
Fax Number	:

Provider Business Practice Location Address
First Line	:	2028 E HARBOR RD
Second Line	:
City	:	PORT CLINTON
State	:	OH
Zip	:	43452-1511
Country	:	US
Telephone Number	:	419-732-6452
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2007
Last Update Date	:	09/27/2008

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