Provider Demographics
NPI:1902208218
Name:JOHNSON, LESLIE JANELLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:JANELLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:JANELLE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3630 US HIGHWAY 41 W
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855
Mailing Address - Country:US
Mailing Address - Phone:435-660-9497
Mailing Address - Fax:
Practice Address - Street 1:3630 US HIGHWAY 41 W
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855
Practice Address - Country:US
Practice Address - Phone:906-662-6310
Practice Address - Fax:906-662-6365
Is Sole Proprietor?:No
Enumeration Date:2014-09-17
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7771688-1701183500000X
KS1-16209183500000X
MI5302044192183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist