Provider Demographics
NPI:1659777167
Name:SHIRTS, LESLIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:SHIRTS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4820 N ROAD 68
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-9009
Mailing Address - Country:US
Mailing Address - Phone:509-549-7947
Mailing Address - Fax:509-543-7949
Practice Address - Street 1:4820 N ROAD 68
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-9009
Practice Address - Country:US
Practice Address - Phone:509-549-7947
Practice Address - Fax:509-543-7949
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60418728183500000X
UT6999368-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist