Provider Demographics
NPI:1124039292
Name:FRAZIER, LESLIE SUZANNE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:SUZANNE
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:LESLIE
Other - Middle Name:SUZANNE
Other - Last Name:LASETER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:2104 JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-2711
Mailing Address - Country:US
Mailing Address - Phone:573-778-4245
Mailing Address - Fax:
Practice Address - Street 1:1500 N WESTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-3318
Practice Address - Country:US
Practice Address - Phone:573-778-4245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO045229183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist