Provider Demographics
NPI:1083216691
Name:MISIOLEK, LEIA XIAO (PHARMD)
Entity Type:Individual
Prefix:
First Name:LEIA
Middle Name:XIAO
Last Name:MISIOLEK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:LEIA
Other - Middle Name:XIAO
Other - Last Name:ZINK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2147 E 14 MILE RD APT 201
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-5929
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18400 HALL RD
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-4875
Practice Address - Country:US
Practice Address - Phone:586-263-7690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302412036183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist