Provider Demographics
NPI:1053079111
Name:LEVENTOFF, NANCY
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:LEVENTOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5796
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:OR
Mailing Address - Zip Code:97420-0645
Mailing Address - Country:US
Mailing Address - Phone:800-859-3296
Mailing Address - Fax:
Practice Address - Street 1:1775 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2125
Practice Address - Country:US
Practice Address - Phone:800-859-3296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-00117701835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology