Provider Demographics
NPI:1912692575
Name:LEGGETT, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:LEGGETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1458 MOUNT PLEASANT RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-3934
Mailing Address - Country:US
Mailing Address - Phone:757-482-4877
Mailing Address - Fax:757-546-0909
Practice Address - Street 1:1458 MOUNT PLEASANT RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-3934
Practice Address - Country:US
Practice Address - Phone:757-482-4877
Practice Address - Fax:757-546-0909
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0230030630183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician