Provider Demographics
NPI:1740563519
Name:RIDDLE, LESLIE ELAINE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:ELAINE
Last Name:RIDDLE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 ARCH ST
Mailing Address - Street 2:APT 6
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-2169
Mailing Address - Country:US
Mailing Address - Phone:518-466-4650
Mailing Address - Fax:
Practice Address - Street 1:476 CANAL ST
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-6621
Practice Address - Country:US
Practice Address - Phone:802-254-5633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.0052945183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist