Provider Demographics
NPI:1710260302
Name:SPELLMEIER, LESLIE III
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:
Last Name:SPELLMEIER
Suffix:III
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3630 SW WANAMAKER RD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614
Mailing Address - Country:US
Mailing Address - Phone:785-228-5656
Mailing Address - Fax:
Practice Address - Street 1:3630 SW WANAMAKER RD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-4528
Practice Address - Country:US
Practice Address - Phone:785-228-5656
Practice Address - Fax:785-228-5644
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-13801183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist