1891982351 NPI number — LOIS FAITH LEISTER RPH, MS, MBA

Table of content: LOIS FAITH LEISTER RPH, MS, MBA (NPI 1891982351)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891982351 NPI number — LOIS FAITH LEISTER RPH, MS, MBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEISTER
Provider First Name:
LOIS
Provider Middle Name:
FAITH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPH, MS, MBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ANDERSON
Provider Other First Name:
LOIS
Provider Other Middle Name:
FAITH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RPH, MS, MBA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891982351
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/28/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 RIVER DR
Provider Second Line Business Mailing Address:
MENDOCINO COAST DISTRICT HOSPITAL PHARMACY
Provider Business Mailing Address City Name:
FORT BRAGG
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95437-5403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-961-1234
Provider Business Mailing Address Fax Number:
707-961-4773

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 RIVER DR
Provider Second Line Business Practice Location Address:
MENDOCINO COAST DISTRICT HOSPITAL PHARMACY
Provider Business Practice Location Address City Name:
FORT BRAGG
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95437-5403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-961-1234
Provider Business Practice Location Address Fax Number:
707-961-4773
Provider Enumeration Date:
09/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  40842 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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