Provider Demographics
NPI:1477820371
Name:WALTERS, LEISHA HOYLAND (PHARMD)
Entity Type:Individual
Prefix:
First Name:LEISHA
Middle Name:HOYLAND
Last Name:WALTERS
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 1:4120 NELSON WAY
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28360-9102
Mailing Address - Country:US
Mailing Address - Phone:910-739-9641
Mailing Address - Fax:910-739-8580
Practice Address - Street 1:2750 N ROBERTS AVE
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2856
Practice Address - Country:US
Practice Address - Phone:910-739-4999
Practice Address - Fax:910-739-8580
Is Sole Proprietor?:No
Enumeration Date:2011-11-19
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13613183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist