Provider Demographics
NPI:1063525970
Name:DINSLAGE, LEROY JOHN (RPH)
Entity type:Individual
Prefix:MR
First Name:LEROY
Middle Name:JOHN
Last Name:DINSLAGE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 E PINEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:NE
Mailing Address - Zip Code:68434-1132
Mailing Address - Country:US
Mailing Address - Phone:402-643-2507
Mailing Address - Fax:402-643-6956
Practice Address - Street 1:1519 W HIGHWAY 34
Practice Address - Street 2:SUITE #1
Practice Address - City:SEWARD
Practice Address - State:NE
Practice Address - Zip Code:68434-2338
Practice Address - Country:US
Practice Address - Phone:402-643-2918
Practice Address - Fax:402-643-6956
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9060183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist