Provider Demographics
NPI:1568996817
Name:SUGIYAMA, LESLIE MICHELLE (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:MICHELLE
Last Name:SUGIYAMA
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2771 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4726
Mailing Address - Country:US
Mailing Address - Phone:707-528-3311
Mailing Address - Fax:707-528-8451
Practice Address - Street 1:2771 4TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4726
Practice Address - Country:US
Practice Address - Phone:707-528-3311
Practice Address - Fax:707-528-8451
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74776183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist