Provider Demographics
NPI:1538392956
Name:LEGNER, DEBRA LYNN (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:LYNN
Last Name:LEGNER
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-0305
Mailing Address - Country:US
Mailing Address - Phone:575-622-3812
Mailing Address - Fax:
Practice Address - Street 1:4500 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-0305
Practice Address - Country:US
Practice Address - Phone:575-622-3812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2014-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007338183500000X
AZS017228183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist