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NPI Code Detail

MEDICARE: MS. CASSANDRA GRACE LEID RPH

MEDICARE: MS. CASSANDRA GRACE LEID 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
11835N1003XNutrition Support PharmacistPH00011460WA
21835P0018XPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistPH00011460WA
31835P1200XPharmacotherapy PharmacistPH00011460WA

General Provider Information

NPI Number : 1285993113
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CASSANDRA GRACE LEID RPH
Provider Business Mailing Address
First Line : 100013 E BRANDON DR
Second Line :
City : KENNEWICK
State : WA
Zip : 99338-7535
Country : US
Telephone Number : 509-554-9923
Fax Number : 509-946-0255
Provider Business Practice Location Address
First Line : 1803 GEORGE WASHINGTON WAY
Second Line :
City : RICHLAND
State : WA
Zip : 99354-2305
Country : US
Telephone Number : 509-946-1157
Fax Number : 509-946-0255
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2012
Last Update Date : 08/29/2015

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