Provider Demographics
NPI:1518146463
Name:LEISING, LISA MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:LEISING
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 1:9025 SESH RD
Mailing Address - Street 2:
Mailing Address - City:CLARENCE CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:14032-9660
Mailing Address - Country:US
Mailing Address - Phone:716-906-0580
Mailing Address - Fax:
Practice Address - Street 1:300 NIAGARA ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14201-2135
Practice Address - Country:US
Practice Address - Phone:716-242-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302031717183500000X
NY046735183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist