Provider Demographics
NPI:1366885691
Name:FOX, LESLIE-ANN I (RPH)
Entity type:Individual
Prefix:MS
First Name:LESLIE-ANN
Middle Name:
Last Name:FOX
Suffix:I
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:LESLIE
Other - Middle Name:
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:PO BOX 585
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:WA
Mailing Address - Zip Code:98941
Mailing Address - Country:US
Mailing Address - Phone:509-649-2340
Mailing Address - Fax:
Practice Address - Street 1:521 EAST MOUNTAIN VIEW AVE
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926
Practice Address - Country:US
Practice Address - Phone:509-649-2340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH0015610183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH00015610OtherLICENSE