Provider Demographics
NPI:1437464278
Name:LEPORTE, LEANDRA (PHARMD)
Entity Type:Individual
Prefix:
First Name:LEANDRA
Middle Name:
Last Name:LEPORTE
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 1:13939 SW PACIFIC HWY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-4838
Mailing Address - Country:US
Mailing Address - Phone:503-970-9812
Mailing Address - Fax:
Practice Address - Street 1:13939 SW PACIFIC HWY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-4838
Practice Address - Country:US
Practice Address - Phone:503-970-9812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0011409-P183500000X
FLPS42371183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist