Provider Demographics
NPI:1134546211
Name:KIEL, LESLIE
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:KIEL
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 1:4161 2ND ST S
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-3761
Mailing Address - Country:US
Mailing Address - Phone:320-253-3280
Mailing Address - Fax:
Practice Address - Street 1:4161 2ND ST S
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-3761
Practice Address - Country:US
Practice Address - Phone:320-253-3280
Practice Address - Fax:320-253-5790
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117232183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist