MEDICARE: LESLIE PLUMLEE RRPH. R.D.

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	26019003A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	26019003A	OTHER	IN	PHARMACIST LICENSE
2	16139	OTHER	IN	REGISTERED DIETITIAN

General Provider Information

NPI Number	:	1457406548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE PLUMLEE RRPH. R.D.

Provider Business Mailing Address
First Line	:	2998 EAST SAINT ANDREWS ROAD
Second Line	:
City	:	WINONA LAKE
State	:	IN
Zip	:	46590
Country	:	US
Telephone Number	:	574-268-2010
Fax Number	:	574-268-1045

Provider Business Practice Location Address
First Line	:	2998 EAST SAINT ANDREWS ROAD
Second Line	:
City	:	WINONA LAKE
State	:	IN
Zip	:	46590
Country	:	US
Telephone Number	:	574-268-2010
Fax Number	:	574-268-1045

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

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	07/08/2007

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