Provider Demographics
NPI:1013511237
Name:DOYLE, LESLIE S
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:S
Last Name:DOYLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 SQUIRE RD
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-1863
Mailing Address - Country:US
Mailing Address - Phone:781-289-6879
Mailing Address - Fax:844-411-6206
Practice Address - Street 1:540 SQUIRE RD
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-1863
Practice Address - Country:US
Practice Address - Phone:781-289-6879
Practice Address - Fax:844-411-6206
Is Sole Proprietor?:No
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17033183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist