Provider Demographics
NPI:1942592761
Name:KERWIN, LESLIE YAZLUK (RPH)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:YAZLUK
Last Name:KERWIN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 WHITE GATE RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06478-1502
Mailing Address - Country:US
Mailing Address - Phone:203-525-4777
Mailing Address - Fax:
Practice Address - Street 1:435 MAIN ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-1151
Practice Address - Country:US
Practice Address - Phone:203-261-6493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7371183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist