Provider Demographics
NPI:1154663698
Name:PHILLIPS, LESLIE M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:M
Last Name:PHILLIPS
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 1:1100 SHIRLEY ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-1370
Mailing Address - Country:US
Mailing Address - Phone:803-252-1979
Mailing Address - Fax:803-779-7212
Practice Address - Street 1:1100 SHIRLEY ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-1370
Practice Address - Country:US
Practice Address - Phone:803-252-1979
Practice Address - Fax:803-779-7212
Is Sole Proprietor?:No
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC125951835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric