Provider Demographics
NPI:1497225577
Name:LESHER, ADAM
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:LESHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 N HIGHWAY 66 STE A
Mailing Address - Street 2:
Mailing Address - City:CATOOSA
Mailing Address - State:OK
Mailing Address - Zip Code:74015-3052
Mailing Address - Country:US
Mailing Address - Phone:918-739-4774
Mailing Address - Fax:
Practice Address - Street 1:1818 N HIGHWAY 66 STE A
Practice Address - Street 2:
Practice Address - City:CATOOSA
Practice Address - State:OK
Practice Address - Zip Code:74015-3052
Practice Address - Country:US
Practice Address - Phone:918-739-4774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13950183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist