Provider Demographics
NPI:1578050639
Name:LESKELA, SUZANN K (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SUZANN
Middle Name:K
Last Name:LESKELA
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 1:1611 WILDEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-1247
Mailing Address - Country:US
Mailing Address - Phone:405-821-4278
Mailing Address - Fax:
Practice Address - Street 1:1111 N COMMERCE ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-3922
Practice Address - Country:US
Practice Address - Phone:580-226-6978
Practice Address - Fax:580-226-7543
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-15
Last Update Date:2018-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16951183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist