Provider Demographics
NPI:1164556791
Name:ALLEN, LESLIE C (RPH)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:C
Last Name:ALLEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116033 FLEECER RD
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59750-9710
Mailing Address - Country:US
Mailing Address - Phone:406-723-9106
Mailing Address - Fax:406-723-9106
Practice Address - Street 1:116033 FLEECER RD
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59750-9710
Practice Address - Country:US
Practice Address - Phone:406-723-9106
Practice Address - Fax:406-723-9106
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2856183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist