Basic Information
| Provider Information | |||||||||
| NPI: | 1518202266 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CUMBERBATCH | ||||||||
| FirstName: | LEAH | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | PHARMD. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1701 E COLTER ST UNIT 109 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850163369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8323852103 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2345 E BASELINE RD | ||||||||
| Address2: | |||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852342326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808924978 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2012 | ||||||||
| LastUpdateDate: | 12/06/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | S019581 | AR | Y | Pharmacy Service Providers | Pharmacist | 183500000X | 52579 | TX | N | Pharmacy Service Providers | Pharmacist |
No ID Information.