Provider Demographics
NPI:1104532415
Name:PROBST, LESA M (PHARMD BS PHARM)
Entity type:Individual
Prefix:DR
First Name:LESA
Middle Name:M
Last Name:PROBST
Suffix:
Gender:F
Credentials:PHARMD BS PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4815 HYDE RD
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-9461
Mailing Address - Country:US
Mailing Address - Phone:315-436-5319
Mailing Address - Fax:844-444-1179
Practice Address - Street 1:6700 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13211
Practice Address - Country:US
Practice Address - Phone:315-579-4386
Practice Address - Fax:315-437-7409
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY407771835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist