Provider Demographics
NPI:1891982351
Name:LEISTER, LOIS FAITH (RPH, MS, MBA)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:FAITH
Last Name:LEISTER
Suffix:
Gender:F
Credentials:RPH, MS, MBA
Other - Prefix:
Other - First Name:LOIS
Other - Middle Name:FAITH
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH, MS, MBA
Mailing Address - Street 1:700 RIVER DR
Mailing Address - Street 2:MENDOCINO COAST DISTRICT HOSPITAL PHARMACY
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437-5403
Mailing Address - Country:US
Mailing Address - Phone:707-961-1234
Mailing Address - Fax:707-961-4773
Practice Address - Street 1:700 RIVER DR
Practice Address - Street 2:MENDOCINO COAST DISTRICT HOSPITAL PHARMACY
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-5403
Practice Address - Country:US
Practice Address - Phone:707-961-1234
Practice Address - Fax:707-961-4773
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40842183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist