Individual
LESLIE ELIZABETH MAHMUTAGIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPHT
Contact information
Practice address
1108 N 14TH ST, SHEBOYGAN, WI 53081-3213
(920) 452-0079
Mailing address
1026A CLARA AVE, SHEBOYGAN, WI 53081-5316
(920) 254-0792
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
30118715
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NA
—
Enumeration date
04/10/2021
Last updated
04/10/2021
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