Provider Demographics
NPI:1508948118
Name:LIESKE, LLOYD FREDERICK JR (RPH)
Entity type:Individual
Prefix:
First Name:LLOYD
Middle Name:FREDERICK
Last Name:LIESKE
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 OXFORD AVE
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-7614
Mailing Address - Country:US
Mailing Address - Phone:509-539-8605
Mailing Address - Fax:
Practice Address - Street 1:690 GAGE BLVD
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-9512
Practice Address - Country:US
Practice Address - Phone:509-627-5133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH000095421835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy