MEDICARE: MS. LORI MARISA LEAL PHARM D

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	44720	TX

General Provider Information

NPI Number	:	1194947408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LORI MARISA LEAL PHARM D

Provider Business Mailing Address
First Line	:	204 DELANO ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77003-2319
Country	:	US
Telephone Number	:	713-222-0442
Fax Number	:	713-222-0442

Provider Business Practice Location Address
First Line	:	2025 MANGUM RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77092-8529
Country	:	US
Telephone Number	:	713-812-8400
Fax Number	:	713-812-8401

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

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	07/08/2007

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