Provider Demographics
NPI:1003415027
Name:ROSE, LESLEY ERIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:ERIN
Last Name:ROSE
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 1:2009 LITTLE STREAM RUN
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1892
Mailing Address - Country:US
Mailing Address - Phone:270-993-6699
Mailing Address - Fax:
Practice Address - Street 1:1670 STARLITE DR
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-3339
Practice Address - Country:US
Practice Address - Phone:270-926-2340
Practice Address - Fax:270-926-3864
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY015439183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist