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General NPI Number Information
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NPI Number | 1740563519
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Entity Type | Individual
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Provider Name | LESLIE ELAINE RIDDLE PHARM. D.
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Gender | Female
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Dates
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Enumeration Date | 09/27/2011
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Last Update Date | 09/27/2011
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Provider Practice Location Address
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Address Line | 476 CANAL ST
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City | BRATTLEBORO
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State | VT
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Zip | 05301-6621
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Country | US
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Telephone | 802-254-5633
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Fax |
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Provider Business Mailing Address
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Address Line | 110 ARCH ST APT 6
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City | KEENE
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State | NH
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Zip | 03431-2169
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Country | US
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Telephone | 518-466-4650
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 033.0052945
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License Number State | VT
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