MEDICARE: MRS. LESLIE DIANE JOHNSON RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	35949	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003878513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LESLIE DIANE JOHNSON RPH

Provider Business Mailing Address
First Line	:	99 E CHAUTAUQUA ST
Second Line	:	SUITE 3
City	:	MAYVILLE
State	:	NY
Zip	:	14757-1017
Country	:	US
Telephone Number	:	716-753-3200
Fax Number	:	716-753-3206

Provider Business Practice Location Address
First Line	:	99 E CHAUTAUQUA ST
Second Line	:	SUITE 3
City	:	MAYVILLE
State	:	NY
Zip	:	14757-1017
Country	:	US
Telephone Number	:	716-753-3200
Fax Number	:	716-753-3206

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	07/23/2009

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