Provider Demographics
NPI:1871810283
Name:MCCLESKEY, LEWIS DALE (RPH)
Entity type:Individual
Prefix:MR
First Name:LEWIS
Middle Name:DALE
Last Name:MCCLESKEY
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 1:1445 WYOMING BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-3849
Mailing Address - Country:US
Mailing Address - Phone:505-299-4496
Mailing Address - Fax:505-299-7713
Practice Address - Street 1:1445 WYOMING BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-3849
Practice Address - Country:US
Practice Address - Phone:505-299-4496
Practice Address - Fax:505-299-7713
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-24
Last Update Date:2010-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00003454183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist