Provider Demographics
NPI:1063681328
Name:MANDANAS, LEIGHIA WILLIS (RPH)
Entity Type:Individual
Prefix:
First Name:LEIGHIA
Middle Name:WILLIS
Last Name:MANDANAS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:LEIGHIA
Other - Middle Name:
Other - Last Name:WILLIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:320 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-3102
Mailing Address - Country:US
Mailing Address - Phone:212-279-2856
Mailing Address - Fax:212-279-1358
Practice Address - Street 1:320 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3102
Practice Address - Country:US
Practice Address - Phone:212-279-2856
Practice Address - Fax:212-279-1358
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048291183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist