Provider Demographics
NPI:1497887137
Name:LEONARD, LESLIE LEE (DPH)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:LEE
Last Name:LEONARD
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:LEE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPH
Mailing Address - Street 1:1321 SHADYBROOK COVE LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-5828
Mailing Address - Country:US
Mailing Address - Phone:865-207-3770
Mailing Address - Fax:
Practice Address - Street 1:1321 SHADYBROOK COVE LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-5828
Practice Address - Country:US
Practice Address - Phone:865-207-3770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNC-9590183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist