Provider Demographics
NPI:1750416079
Name:BRISCOE-DWYER, LEIGH ANN (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:LEIGH
Middle Name:ANN
Last Name:BRISCOE-DWYER
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2073 COUNTY HIGHWAY 10
Mailing Address - Street 2:
Mailing Address - City:LAURENS
Mailing Address - State:NY
Mailing Address - Zip Code:13796-1120
Mailing Address - Country:US
Mailing Address - Phone:607-547-3680
Mailing Address - Fax:607-547-3629
Practice Address - Street 1:1979 MARCUS AVE SUITE E-124
Practice Address - Street 2:
Practice Address - City:LAKE SUCCESS
Practice Address - State:NY
Practice Address - Zip Code:11042
Practice Address - Country:US
Practice Address - Phone:516-396-6248
Practice Address - Fax:516-396-6162
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0380151835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy