Provider Demographics
NPI:1871884221
Name:PATRICK, LESLIE A (RPH)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:A
Last Name:PATRICK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 E TAFT RD
Mailing Address - Street 2:
Mailing Address - City:ASHLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48806-9716
Mailing Address - Country:US
Mailing Address - Phone:989-838-4404
Mailing Address - Fax:
Practice Address - Street 1:2119 S US HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:MI
Practice Address - Zip Code:48879-9166
Practice Address - Country:US
Practice Address - Phone:989-224-8976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302023887183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist