Provider Demographics
NPI:1316379522
Name:LEIVA, MAYA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MAYA
Middle Name:
Last Name:LEIVA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 WESTHAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-9741
Mailing Address - Country:US
Mailing Address - Phone:415-310-3687
Mailing Address - Fax:
Practice Address - Street 1:577 MEADOW ST
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01013-1876
Practice Address - Country:US
Practice Address - Phone:413-592-4696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA234510183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist