Leslie Elizabeth Mahmutagic, CPHT

Primary specialty

Pharmacy TechnicianTaxonomy code 183700000X

License

30118715 Issued in WI

Practice address

1108 N 14TH St
Sheboygan, WI 53081-3213

Phone

(920) 452-0079

NPI assigned

Apr 10, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Leslie Elizabeth Valdez Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wisconsin CVS Pharmacy LLC

  • Pharmacy
  • Glendale, WI
  • NPI 1649947573
  NPD (past)
• Wisconsin CVS Pharmacy, L.L.C.

  • Pharmacy
  • Sheboygan, WI
  • NPI 1265813364
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1618012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618012800000",
    "number": "1154901544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1026A CLARA AVE",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530815316",
            "telephone_number": "920-254-0792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1108 N 14TH ST",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530813213",
            "telephone_number": "920-452-0079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHMUTAGIC",
        "first_name": "LESLIE",
        "middle_name": "ELIZABETH",
        "credential": "CPHT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-10",
        "last_updated": "2021-04-10",
        "certification_date": "2021-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183700000X",
            "taxonomy_group": "",
            "desc": "Pharmacy Technician",
            "state": "WI",
            "license": "30118715",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NA",
            "identifier": "NA",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lm-3700@hpeprint.com",
            "affiliation": "N",
            "endpointDescription": "fax",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1026A Clara Ave",
            "city": "Sheboygan",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530815316",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "LESLIE",
            "last_name": "VALDEZ",
            "middle_name": "ELIZABETH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Shannon Macnab, O.D.
• Christopher Mader, CSAC
• David J Madigan, CRNA
• William Madson
• James C Magestro, DDS
• June Maile, RN, CDE
• Laura Renee Maki, SAC-IT
• Sabrina Marie Malson, M.S., CF-SLP
• Dean A Mancheski, M.D.
• Laura Elizabeth Manning, RN-BSN

• Pharmacy Technician in Sheboygan, WI
• Providers in Sheboygan, WI by specialty
• Pharmacy Technician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.