Provider Demographics
NPI:1326806100
Name:CREASEY, LETICIA (RPH)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:CREASEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 COOLEY MESA RD
Mailing Address - Street 2:
Mailing Address - City:GYPSUM
Mailing Address - State:CO
Mailing Address - Zip Code:81637-5055
Mailing Address - Country:US
Mailing Address - Phone:970-328-7610
Mailing Address - Fax:
Practice Address - Street 1:170 COOLEY MESA RD
Practice Address - Street 2:
Practice Address - City:GYPSUM
Practice Address - State:CO
Practice Address - Zip Code:81637-5055
Practice Address - Country:US
Practice Address - Phone:970-328-7610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0014336183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist