Provider Demographics
NPI:1003523960
Name:RECCIUS, LESLIE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:
Last Name:RECCIUS
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 1:64 ALYSSA WAY
Mailing Address - Street 2:
Mailing Address - City:FISHERVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40023-7581
Mailing Address - Country:US
Mailing Address - Phone:502-741-6455
Mailing Address - Fax:
Practice Address - Street 1:2401 TERRA CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-5395
Practice Address - Country:US
Practice Address - Phone:502-210-4295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0154751835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist