Provider Demographics
NPI:1417548785
Name:LOWE, LESLIE (RPH)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:LOWE
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 1:50 COUCH ST
Mailing Address - Street 2:
Mailing Address - City:SENOIA
Mailing Address - State:GA
Mailing Address - Zip Code:30276-1832
Mailing Address - Country:US
Mailing Address - Phone:925-999-5767
Mailing Address - Fax:
Practice Address - Street 1:1200 HIGHWAY 74 S STE 20
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-3071
Practice Address - Country:US
Practice Address - Phone:770-486-0133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH032546183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist