Provider Demographics
NPI:1346526795
Name:PELL, LESLIE J (PHARMD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:J
Last Name:PELL
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 1:1112 PINENEEDLE RD
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-8453
Mailing Address - Country:US
Mailing Address - Phone:412-508-0643
Mailing Address - Fax:
Practice Address - Street 1:1112 PINENEEDLE RD
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-8453
Practice Address - Country:US
Practice Address - Phone:412-508-0643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13570183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist