Provider Demographics
NPI:1417295502
Name:GADSDEN, LESLEY ELTON (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:LESLEY
Middle Name:ELTON
Last Name:GADSDEN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3922 EVANS MILL RD
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-4101
Mailing Address - Country:US
Mailing Address - Phone:770-484-7046
Mailing Address - Fax:
Practice Address - Street 1:3045 PANOLA RD
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-2317
Practice Address - Country:US
Practice Address - Phone:770-322-5480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH015343183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist