Healthcare Provider Details

I. General information

NPI: 1710975735
Provider Name (Legal Business Name): LARRY OMER LESKE R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 S WASHINGTON ST
REDWOOD FALLS MN
56283-1656
US

IV. Provider business mailing address

108 CYPRESSWOOD LN
REDWOOD FALLS MN
56283-1308
US

V. Phone/Fax

Practice location:
  • Phone: 507-637-3549
  • Fax: 507-637-3613
Mailing address:
  • Phone: 507-627-3242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number112183-6
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: