Provider Demographics
NPI:1558649434
Name:MANOR, LESLIE CAROL (RPH)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:CAROL
Last Name:MANOR
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:LESLIE
Other - Middle Name:CAROL
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:4865 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-1932
Mailing Address - Country:US
Mailing Address - Phone:513-858-4714
Mailing Address - Fax:513-858-4818
Practice Address - Street 1:4865 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-1932
Practice Address - Country:US
Practice Address - Phone:513-858-4714
Practice Address - Fax:513-858-4818
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH032165991835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHNPI1130Medicaid