Provider Demographics
NPI:1720238108
Name:LEOMBRUNI, LISA MICHELLE (PHARM D)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELLE
Last Name:LEOMBRUNI
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:PINON
Mailing Address - State:AZ
Mailing Address - Zip Code:86510-0010
Mailing Address - Country:US
Mailing Address - Phone:928-725-9514
Mailing Address - Fax:925-725-9542
Practice Address - Street 1:2 MILES EAST OF PINON-NR4
Practice Address - Street 2:
Practice Address - City:PINON
Practice Address - State:AZ
Practice Address - Zip Code:86510-0010
Practice Address - Country:US
Practice Address - Phone:928-725-9514
Practice Address - Fax:928-725-9542
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26022992A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist