Provider Demographics
NPI:1316149388
Name:THELEMAQUE, LESLY (RPH)
Entity type:Individual
Prefix:MR
First Name:LESLY
Middle Name:
Last Name:THELEMAQUE
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 1:95 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-5410
Mailing Address - Country:US
Mailing Address - Phone:516-795-7695
Mailing Address - Fax:
Practice Address - Street 1:2141 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-3001
Practice Address - Country:US
Practice Address - Phone:718-434-1211
Practice Address - Fax:718-859-6751
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2016-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041951-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist