Provider Demographics
NPI:1477627289
Name:HAAG, LESLIE MANES (PHARM D)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:MANES
Last Name:HAAG
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 SPRINGFIELD DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-2831
Mailing Address - Country:US
Mailing Address - Phone:561-543-9671
Mailing Address - Fax:
Practice Address - Street 1:3969 S MILITARY TRL
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-3433
Practice Address - Country:US
Practice Address - Phone:561-641-1771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40285183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist