Provider Demographics
NPI:1154600864
Name:LEBERKNIGHT, TERESA K (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:K
Last Name:LEBERKNIGHT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 MONTANO RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-5746
Mailing Address - Country:US
Mailing Address - Phone:505-922-6323
Mailing Address - Fax:505-922-6324
Practice Address - Street 1:4201 MONTANO RD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-5746
Practice Address - Country:US
Practice Address - Phone:505-922-6323
Practice Address - Fax:505-922-6324
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007463183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist