Provider Demographics
NPI:1619430063
Name:MINER, LEANNA M (RPH)
Entity Type:Individual
Prefix:DR
First Name:LEANNA
Middle Name:M
Last Name:MINER
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 1:530 SUMMERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:STAYTON
Mailing Address - State:OR
Mailing Address - Zip Code:97383-1397
Mailing Address - Country:US
Mailing Address - Phone:631-848-9242
Mailing Address - Fax:
Practice Address - Street 1:3169 CRATER LAKE HWY
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-9179
Practice Address - Country:US
Practice Address - Phone:541-774-4346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0017010183500000X, 1835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No183500000XPharmacy Service ProvidersPharmacist