Provider Demographics
NPI:1053501064
Name:LEIS, ASHLEY MICHELLE (PHARMD, RPH)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:MICHELLE
Last Name:LEIS
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2028 E HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452-1511
Mailing Address - Country:US
Mailing Address - Phone:419-732-6452
Mailing Address - Fax:
Practice Address - Street 1:2028 E HARBOR RD
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-1511
Practice Address - Country:US
Practice Address - Phone:419-732-6452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2008-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-28100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist