Provider Demographics
NPI:1184266488
Name:KALASH, LESLIE DENIS (RPH,MSPHARM)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:DENIS
Last Name:KALASH
Suffix:
Gender:M
Credentials:RPH,MSPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 RED CEDAR RUN
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-1349
Mailing Address - Country:US
Mailing Address - Phone:732-370-3949
Mailing Address - Fax:
Practice Address - Street 1:11 RED CEDAR RUN
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-1349
Practice Address - Country:US
Practice Address - Phone:732-370-3949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01924400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist