Provider Demographics
NPI:1164843496
Name:BRILES, LEESA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LEESA
Middle Name:
Last Name:BRILES
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 1:477 HIGHWAY 79
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:TN
Mailing Address - Zip Code:37058-6941
Mailing Address - Country:US
Mailing Address - Phone:931-232-4008
Mailing Address - Fax:931-232-8844
Practice Address - Street 1:477 HIGHWAY 79
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:TN
Practice Address - Zip Code:37058-6941
Practice Address - Country:US
Practice Address - Phone:931-232-4008
Practice Address - Fax:931-232-8844
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37867183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist