Provider Demographics
NPI:1275621450
Name:BROWN, LESLIE BENNETT (RPH)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:BENNETT
Last Name:BROWN
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 1:512 SW 117TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-1140
Mailing Address - Country:US
Mailing Address - Phone:352-332-9859
Mailing Address - Fax:352-472-8776
Practice Address - Street 1:24220 W NEWBERRY RD
Practice Address - Street 2:HOMETOWN PHARMACY
Practice Address - City:NEWBERRY
Practice Address - State:FL
Practice Address - Zip Code:32669-2211
Practice Address - Country:US
Practice Address - Phone:352-472-9001
Practice Address - Fax:352-472-8776
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 21107183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist