Provider Demographics
NPI:1710473335
Name:SHERRARD, LESLIE MICHELE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:MICHELE
Last Name:SHERRARD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:LESLIE
Other - Middle Name:MICHELE
Other - Last Name:SEWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:2706 TAHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-5097
Mailing Address - Country:US
Mailing Address - Phone:509-952-0867
Mailing Address - Fax:
Practice Address - Street 1:402 S 4TH AVE STE E127
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3546
Practice Address - Country:US
Practice Address - Phone:509-248-5153
Practice Address - Fax:509-972-6470
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00016606183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist