MEDICARE: MR. LESLY THELEMAQUE RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	041951-1	NY

General Provider Information

NPI Number	:	1316149388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LESLY THELEMAQUE RPH

Provider Business Mailing Address
First Line	:	95 COLONIAL DR
Second Line	:
City	:	MASSAPEQUA
State	:	NY
Zip	:	11758-5410
Country	:	US
Telephone Number	:	516-795-7695
Fax Number	:

Provider Business Practice Location Address
First Line	:	2141 NOSTRAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-3001
Country	:	US
Telephone Number	:	718-434-1211
Fax Number	:	718-859-6751

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2007
Last Update Date	:	05/01/2016

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