Provider Demographics
NPI:1013223270
Name:WILTSEE, LESLEY ANN (RPH)
Entity Type:Individual
Prefix:MS
First Name:LESLEY
Middle Name:ANN
Last Name:WILTSEE
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 1:20 PELHAM DR
Mailing Address - Street 2:
Mailing Address - City:WEST DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08051-1737
Mailing Address - Country:US
Mailing Address - Phone:856-468-1518
Mailing Address - Fax:
Practice Address - Street 1:1000 KINGS HWY
Practice Address - Street 2:
Practice Address - City:WEST DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08086-2216
Practice Address - Country:US
Practice Address - Phone:856-853-2943
Practice Address - Fax:856-853-2947
Is Sole Proprietor?:No
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01508800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI01508800OtherNEW JERSEY STATE BOARD OF PHARMACY