Provider Demographics
NPI:1578865705
Name:SCHROEDER, LESLIE D (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:D
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:LESLIE
Other - Middle Name:K
Other - Last Name:DEEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:5824 W 68TH ST
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-1363
Mailing Address - Country:US
Mailing Address - Phone:952-941-4215
Mailing Address - Fax:
Practice Address - Street 1:9 W 14TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-2478
Practice Address - Country:US
Practice Address - Phone:612-354-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN115424183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist