Provider Demographics
NPI:1093841975
Name:HOFAMMANN, LESLIE KELLER (RPH)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:KELLER
Last Name:HOFAMMANN
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 1:2320 BROOKSIDE DR SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-6616
Mailing Address - Country:US
Mailing Address - Phone:256-350-4483
Mailing Address - Fax:
Practice Address - Street 1:1302 SOMERVILLE RD SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-4337
Practice Address - Country:US
Practice Address - Phone:256-355-8015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9030183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist