Provider Demographics
NPI:1194167726
Name:WINNER, LEAH MICHELLE (PHARMD)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:MICHELLE
Last Name:WINNER
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 1:675 TROY SCHENECTADY RD
Mailing Address - Street 2:T-1915
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2493
Mailing Address - Country:US
Mailing Address - Phone:518-782-1360
Mailing Address - Fax:518-218-5052
Practice Address - Street 1:675 TROY SCHENECTADY RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2493
Practice Address - Country:US
Practice Address - Phone:518-782-1360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2015-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058201183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist