Provider Demographics
NPI:1659607448
Name:LAVERY, LESLI ANNE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LESLI
Middle Name:ANNE
Last Name:LAVERY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:LESLI
Other - Middle Name:ANNE
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:43112 15TH ST W
Mailing Address - Street 2:INFUSION PHARMACY ROOM 1434
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-6219
Mailing Address - Country:US
Mailing Address - Phone:661-726-2369
Mailing Address - Fax:661-726-2385
Practice Address - Street 1:43112 15TH ST W
Practice Address - Street 2:INFUSION PHARMACY ROOM 1434
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-6219
Practice Address - Country:US
Practice Address - Phone:661-726-2369
Practice Address - Fax:661-726-2385
Is Sole Proprietor?:No
Enumeration Date:2009-10-28
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302036594183500000X
CA636161835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology
No183500000XPharmacy Service ProvidersPharmacist