Basic Information
| Provider Information | |||||||||
| NPI: | 1518146463 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEISING | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | R.PH. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9025 SESH RD | ||||||||
| Address2: | |||||||||
| City: | CLARENCE CENTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140329660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7169060580 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 300 NIAGARA ST | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142012135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7162428600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2007 | ||||||||
| LastUpdateDate: | 03/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 5302031717 | MI | N | Pharmacy Service Providers | Pharmacist | 183500000X | 046735 | NY | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.