Provider Demographics
NPI:1598353237
Name:CARRON, LESLIE LOETA (CPHT)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:LOETA
Last Name:CARRON
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 W HERON ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-6224
Mailing Address - Country:US
Mailing Address - Phone:360-532-8743
Mailing Address - Fax:360-538-0063
Practice Address - Street 1:221 W HERON ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-6224
Practice Address - Country:US
Practice Address - Phone:360-532-8743
Practice Address - Fax:360-538-0063
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA60309819183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician