Healthcare Provider Details

I. General information

NPI: 1093841975
Provider Name (Legal Business Name): LESLIE KELLER HOFAMMANN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 SOMERVILLE RD SE
DECATUR AL
35601-4337
US

IV. Provider business mailing address

2320 BROOKSIDE DR SE
DECATUR AL
35601-6616
US

V. Phone/Fax

Practice location:
  • Phone: 256-355-8015
  • Fax:
Mailing address:
  • Phone: 256-350-4483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9030
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: