Provider Demographics
NPI:1326331174
Name:SMITH, LESLIE JOANNE (RPH)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:JOANNE
Last Name:SMITH
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:PO BOX 52
Mailing Address - Street 2:
Mailing Address - City:HARROGATE
Mailing Address - State:TN
Mailing Address - Zip Code:37752-0052
Mailing Address - Country:US
Mailing Address - Phone:423-869-4936
Mailing Address - Fax:
Practice Address - Street 1:515 N 12TH ST
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-1131
Practice Address - Country:US
Practice Address - Phone:606-248-2098
Practice Address - Fax:606-248-0539
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5452183500000X
KY9502183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist