Provider Demographics
NPI:1710975735
Name:LESKE, LARRY OMER (RPH)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:OMER
Last Name:LESKE
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 1:108 CYPRESSWOOD LN
Mailing Address - Street 2:
Mailing Address - City:REDWOOD FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56283-1308
Mailing Address - Country:US
Mailing Address - Phone:507-627-3242
Mailing Address - Fax:
Practice Address - Street 1:216 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:REDWOOD FALLS
Practice Address - State:MN
Practice Address - Zip Code:56283-1656
Practice Address - Country:US
Practice Address - Phone:507-637-3549
Practice Address - Fax:507-637-3613
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN112183-6183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist