Provider Demographics
NPI:1629250782
Name:SARKISOVA, LEEZA V (PHARMACIST, PHARMD)
Entity Type:Individual
Prefix:MS
First Name:LEEZA
Middle Name:V
Last Name:SARKISOVA
Suffix:
Gender:F
Credentials:PHARMACIST, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9302-3RD AVE
Mailing Address - Street 2:RITE AID PHARMACY
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209
Mailing Address - Country:US
Mailing Address - Phone:718-491-0442
Mailing Address - Fax:718-491-6155
Practice Address - Street 1:9302 3RD AVE
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209
Practice Address - Country:US
Practice Address - Phone:718-491-0442
Practice Address - Fax:718-491-6155
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049393183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist