Healthcare Provider Details

I. General information

NPI: 1053423194
Provider Name (Legal Business Name): LESLIE ANN JURIK PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 WEISS ST
SAGINAW MI
48602-5251
US

IV. Provider business mailing address

3866 N GLEANER RD
FREELAND MI
48623-9213
US

V. Phone/Fax

Practice location:
  • Phone: 989-497-2500
  • Fax: 989-791-2435
Mailing address:
  • Phone: 989-642-8178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number5302032515
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: