Provider Demographics
NPI:1154455186
Name:TOLLEFSEN, LESLIE CHARLES (RPH)
Entity Type:Individual
Prefix:MR
First Name:LESLIE
Middle Name:CHARLES
Last Name:TOLLEFSEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2206 TEAL CT
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-3386
Mailing Address - Country:US
Mailing Address - Phone:136-067-1453
Mailing Address - Fax:136-067-1453
Practice Address - Street 1:1275 E SUNSET DR
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-3506
Practice Address - Country:US
Practice Address - Phone:136-065-0153
Practice Address - Fax:360-738-4340
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00009140183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist