Provider Demographics
NPI:1629026778
Name:KNICK, LESLIE WARREN (RPH, PHARMD, BCPP)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:WARREN
Last Name:KNICK
Suffix:
Gender:F
Credentials:RPH, PHARMD, BCPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2500
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24402-2500
Mailing Address - Country:US
Mailing Address - Phone:540-332-8458
Mailing Address - Fax:
Practice Address - Street 1:103 VALLEY CENTER DR
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-5080
Practice Address - Country:US
Practice Address - Phone:540-332-8458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202010473183500000X, 1835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1300XPharmacy Service ProvidersPharmacistPsychiatric