Provider Demographics
NPI:1407254386
Name:HARRISON, LEIA (PHC, PHARMD, RN)
Entity Type:Individual
Prefix:
First Name:LEIA
Middle Name:
Last Name:HARRISON
Suffix:
Gender:F
Credentials:PHC, PHARMD, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 LEGION DR
Mailing Address - Street 2:ALTA VISTA REGIONAL HOSPITAL PHARMACY
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-4804
Mailing Address - Country:US
Mailing Address - Phone:505-426-3500
Mailing Address - Fax:
Practice Address - Street 1:455 SAINT MICHAELS DR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7601
Practice Address - Country:US
Practice Address - Phone:505-913-5287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR49908163W00000X
NMRP00008230183500000X
NMPC000003021835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No163W00000XNursing Service ProvidersRegistered Nurse
No183500000XPharmacy Service ProvidersPharmacist