Provider Demographics
NPI:1932277555
Name:WOLFF, LESLIE ELMER (RPH)
Entity type:Individual
Prefix:MR
First Name:LESLIE
Middle Name:ELMER
Last Name:WOLFF
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 1:16263 IRIS RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-6238
Mailing Address - Country:US
Mailing Address - Phone:320-632-5952
Mailing Address - Fax:320-468-0041
Practice Address - Street 1:207 MAIN ST N
Practice Address - Street 2:
Practice Address - City:PIERZ
Practice Address - State:MN
Practice Address - Zip Code:56364-1517
Practice Address - Country:US
Practice Address - Phone:320-468-6482
Practice Address - Fax:320-468-0041
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN111325-5183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist