Healthcare Provider Details

I. General information

NPI: 1588324560
Provider Name (Legal Business Name): LESLIE MARIE LARABEE RPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2021
Last Update Date: 12/18/2021
Certification Date: 12/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 K ST
SACRAMENTO CA
95814-3509
US

IV. Provider business mailing address

831 K ST
SACRAMENTO CA
95814-3509
US

V. Phone/Fax

Practice location:
  • Phone: 916-444-0690
  • Fax: 916-443-3937
Mailing address:
  • Phone: 916-444-0690
  • Fax: 916-443-3937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number108935
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: