Provider Demographics
NPI:1588062277
Name:LIEBIG, LESLEY BROOKE (PHARMD)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:BROOKE
Last Name:LIEBIG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 E STUART ST APT E47
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-1339
Mailing Address - Country:US
Mailing Address - Phone:308-440-8644
Mailing Address - Fax:
Practice Address - Street 1:1625 E STUART ST APT E47
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-1339
Practice Address - Country:US
Practice Address - Phone:308-440-8644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00205781835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist