Provider Demographics
NPI:1013290055
Name:MYRAN, LEENA (PHARMD, BCPS)
Entity Type:Individual
Prefix:
First Name:LEENA
Middle Name:
Last Name:MYRAN
Suffix:
Gender:F
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:392 BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3649
Mailing Address - Country:US
Mailing Address - Phone:307-760-6209
Mailing Address - Fax:
Practice Address - Street 1:821 E 18TH ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-4775
Practice Address - Country:US
Practice Address - Phone:307-777-7911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0020042183500000X
NV18630183500000X
MT12244183500000X
WY3717183500000X
NE14434183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist