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NPI Code Detail

MEDICARE: COLLEEN LE-LEAVITT PHARMD

MEDICARE: COLLEEN LE-LEAVITT 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
1183500000XPharmacist72959CA

General Provider Information

NPI Number : 1801263058
Entity Type Code : Individual
Provider Name (Legal Business Name) : COLLEEN LE-LEAVITT PHARMD
Provider Business Mailing Address
First Line : 6212 E WIMBLETON CT
Second Line :
City : ORANGE
State : CA
Zip : 92869-6304
Country : US
Telephone Number : 714-657-6195
Fax Number :
Provider Business Practice Location Address
First Line : 4041 N SIERRA WAY
Second Line :
City : SAN BERNARDINO
State : CA
Zip : 92407-3816
Country : US
Telephone Number : 909-881-1813
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2015
Last Update Date : 12/06/2016

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Directions to “ COLLEEN LE-LEAVITT PHARMD” Practice Location

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