Provider Demographics
NPI:1457646325
Name:LAIR, LESLIE ROBERTSON (PHARMD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:ROBERTSON
Last Name:LAIR
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:AMANDA
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1201 W 136TH ST
Mailing Address - Street 2:T1840
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64145-1647
Mailing Address - Country:US
Mailing Address - Phone:816-412-0109
Mailing Address - Fax:816-412-0109
Practice Address - Street 1:1201 W 136TH ST
Practice Address - Street 2:T1840
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64145-1647
Practice Address - Country:US
Practice Address - Phone:816-412-0109
Practice Address - Fax:816-412-0109
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-18
Last Update Date:2011-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010029499183500000X
KS115085183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist