Provider Demographics
NPI:1174977789
Name:LESHINSKI, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:LESHINSKI
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 1:3701 OVERLAND AVE
Mailing Address - Street 2:APT 206
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-6344
Mailing Address - Country:US
Mailing Address - Phone:570-898-7402
Mailing Address - Fax:
Practice Address - Street 1:4009 LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5613
Practice Address - Country:US
Practice Address - Phone:310-823-7152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74595183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist