Provider Demographics
NPI:1700011830
Name:CHOSED, LESLIE ALLEN (RPH)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:ALLEN
Last Name:CHOSED
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 S OCEAN DR
Mailing Address - Street 2:APT. 607
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-3804
Mailing Address - Country:US
Mailing Address - Phone:954-761-7661
Mailing Address - Fax:
Practice Address - Street 1:2000 S OCEAN DR
Practice Address - Street 2:APT. 607
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-3804
Practice Address - Country:US
Practice Address - Phone:954-761-7661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHR1847183500000X
FL18246183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist