Provider Demographics
NPI:1710289004
Name:LEIGH, LINDA (BS CDE CDM)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:LEIGH
Suffix:
Gender:F
Credentials:BS CDE CDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 N CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-3134
Mailing Address - Country:US
Mailing Address - Phone:719-573-6061
Mailing Address - Fax:719-573-1059
Practice Address - Street 1:1121 N CIRCLE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909
Practice Address - Country:US
Practice Address - Phone:719-573-6061
Practice Address - Fax:719-573-1059
Is Sole Proprietor?:No
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18550183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist