Provider Demographics
NPI:1538558267
Name:AVERY, LEILA PATRICIA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LEILA
Middle Name:PATRICIA
Last Name:AVERY
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 1:118 STILLWATER LN
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2777
Mailing Address - Country:US
Mailing Address - Phone:406-546-3826
Mailing Address - Fax:
Practice Address - Street 1:40 W IDAHO ST
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3956
Practice Address - Country:US
Practice Address - Phone:406-257-0714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-19
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4837183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist