Provider Demographics
NPI:1235260266
Name:MILLER, LESLIE JEAN (RPH)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:JEAN
Last Name:MILLER
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 1:2213 BAYBERRY ST
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-1403
Mailing Address - Country:US
Mailing Address - Phone:757-481-1537
Mailing Address - Fax:800-359-5781
Practice Address - Street 1:4425 CORPORATION LN
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3103
Practice Address - Country:US
Practice Address - Phone:757-473-2737
Practice Address - Fax:800-359-5781
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202011202183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist