Provider Demographics
NPI:1679744486
Name:DUPREE, LESLIE SMYTHE (RPH)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:SMYTHE
Last Name:DUPREE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 ORBY CANTRELL HWY
Mailing Address - Street 2:
Mailing Address - City:BIG STONE GAP
Mailing Address - State:VA
Mailing Address - Zip Code:24219-4506
Mailing Address - Country:US
Mailing Address - Phone:276-523-7224
Mailing Address - Fax:
Practice Address - Street 1:605 WOOD AVE E
Practice Address - Street 2:
Practice Address - City:BIG STONE GAP
Practice Address - State:VA
Practice Address - Zip Code:24219-3021
Practice Address - Country:US
Practice Address - Phone:276-523-6052
Practice Address - Fax:276-523-6153
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202205130183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist