Provider Demographics
NPI:1255750071
Name:LESH, MYRON FRANK (RP)
Entity type:Individual
Prefix:MR
First Name:MYRON
Middle Name:FRANK
Last Name:LESH
Suffix:
Gender:M
Credentials:RP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 762
Mailing Address - Street 2:305 E. RIDGEWOOD AVE.
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450
Mailing Address - Country:US
Mailing Address - Phone:201-444-4500
Mailing Address - Fax:201-444-2720
Practice Address - Street 1:305 E. RIDGEWOOD AVE.
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450
Practice Address - Country:US
Practice Address - Phone:201-444-4500
Practice Address - Fax:201-444-2720
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RIO1401700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist