Healthcare Provider Details

I. General information

NPI: 1053501064
Provider Name (Legal Business Name): ASHLEY MICHELLE LEIS PHARMD, RPH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 CEDAR ST
FREMONT OH
43420-1114
US

IV. Provider business mailing address

1700 CEDAR ST
FREMONT OH
43420-1114
US

V. Phone/Fax

Practice location:
  • Phone: 419-332-9187
  • Fax:
Mailing address:
  • Phone: 419-332-9187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03-2-28100
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: