Provider Demographics
NPI:1326647678
Name:ANKLAM, LESLIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:ANKLAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:
Other - Last Name:TONER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:226032 BAYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-6687
Mailing Address - Country:US
Mailing Address - Phone:715-359-3999
Mailing Address - Fax:
Practice Address - Street 1:220 S 18TH AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4221
Practice Address - Country:US
Practice Address - Phone:715-842-3541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14440-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist