Provider Demographics
NPI:1447461504
Name:MCLEISH, FREDERICK PATRICK (RPH)
Entity type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:PATRICK
Last Name:MCLEISH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:ABSECON
Mailing Address - State:NJ
Mailing Address - Zip Code:08201-1923
Mailing Address - Country:US
Mailing Address - Phone:609-641-9807
Mailing Address - Fax:609-641-9807
Practice Address - Street 1:6701 VENTNOR AVE
Practice Address - Street 2:
Practice Address - City:VENTNOR CITY
Practice Address - State:NJ
Practice Address - Zip Code:08406-2151
Practice Address - Country:US
Practice Address - Phone:609-487-8800
Practice Address - Fax:609-487-7531
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01974200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist