Provider Demographics
NPI:1275812869
Name:MCCOURT, LESLIE MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:MARIE
Last Name:MCCOURT
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 1:4951 LAFAYETTE RD
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-9320
Mailing Address - Country:US
Mailing Address - Phone:270-707-1006
Mailing Address - Fax:270-707-1006
Practice Address - Street 1:1213 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-4954
Practice Address - Country:US
Practice Address - Phone:270-886-4594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000033560183500000X
KY012522183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist