Provider Demographics
NPI:1699042267
Name:MORI, LEANNE A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LEANNE
Middle Name:A
Last Name:MORI
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 1:1600 COALTON RD
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:CO
Mailing Address - Zip Code:80027-4630
Mailing Address - Country:US
Mailing Address - Phone:303-465-3024
Mailing Address - Fax:303-465-3404
Practice Address - Street 1:1600 COALTON RD
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:CO
Practice Address - Zip Code:80027-4630
Practice Address - Country:US
Practice Address - Phone:303-465-3024
Practice Address - Fax:303-465-3404
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-25
Last Update Date:2011-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17896183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist