MEDICARE: DR. KEISHA CARDON LASKIE PHARMD

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	RP00006783	NM

General Provider Information

NPI Number	:	1215135504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEISHA CARDON LASKIE PHARMD

Provider Business Mailing Address
First Line	:	211 PONDEROSA WAY
Second Line	:
City	:	JEMEZ SPRINGS
State	:	NM
Zip	:	87025-8002
Country	:	US
Telephone Number	:	505-829-4380
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 PONDEROSA WAY
Second Line	:
City	:	JEMEZ SPRINGS
State	:	NM
Zip	:	87025-8002
Country	:	US
Telephone Number	:	505-829-4380
Fax Number	:

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

Provider Enumeration Date	:	07/06/2007
Last Update Date	:	07/08/2007

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