Provider Demographics
NPI:1336435163
Name:JAGO, LESLIE ANN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:ANN
Last Name:JAGO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:LESLIE
Other - Middle Name:ANN
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22099 CUDDIHY RD
Mailing Address - Street 2:BUILDING 2369
Mailing Address - City:PATUXENT RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:20670-1194
Mailing Address - Country:US
Mailing Address - Phone:301-342-9744
Mailing Address - Fax:301-342-9895
Practice Address - Street 1:22099 CUDDIHY RD
Practice Address - Street 2:BUILDING 2369
Practice Address - City:PATUXENT RIVER
Practice Address - State:MD
Practice Address - Zip Code:20670-1194
Practice Address - Country:US
Practice Address - Phone:301-342-9744
Practice Address - Fax:301-342-9895
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17549183500000X
PARP440506183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist