Provider Demographics
NPI:1356690853
Name:HINES, LEIGH (RPH)
Entity type:Individual
Prefix:
First Name:LEIGH
Middle Name:
Last Name:HINES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:LEIGH
Other - Middle Name:
Other - Last Name:NORTHRIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4265 E RAWHIDE ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-1570
Mailing Address - Country:US
Mailing Address - Phone:702-275-3493
Mailing Address - Fax:
Practice Address - Street 1:1775 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-5732
Practice Address - Country:US
Practice Address - Phone:928-763-8686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS019433183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist