Provider Demographics
NPI:1194067264
Name:CRAMER, LESLIE GEORGE (RPH)
Entity type:Individual
Prefix:MR
First Name:LESLIE
Middle Name:GEORGE
Last Name:CRAMER
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 1:2930 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-4757
Mailing Address - Country:US
Mailing Address - Phone:309-788-7434
Mailing Address - Fax:309-794-2152
Practice Address - Street 1:2930 18TH AVE
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-4757
Practice Address - Country:US
Practice Address - Phone:309-788-7434
Practice Address - Fax:309-794-2152
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17117183500000X
IL051286279183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist