Provider Demographics
NPI:1568186625
Name:TLETSKI, MADELINE GRACE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:GRACE
Last Name:TLETSKI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 TAMAYO CT APT 3
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-8457
Mailing Address - Country:US
Mailing Address - Phone:330-409-5577
Mailing Address - Fax:
Practice Address - Street 1:2650 GATEWAY RD
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-1773
Practice Address - Country:US
Practice Address - Phone:760-795-2540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03441324183500000X
CARPH85967183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist