Provider Demographics
NPI:1689270571
Name:MORROW, LESLI DAWN (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:LESLI
Middle Name:DAWN
Last Name:MORROW
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 E BROAD ST STE 213
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-9171
Mailing Address - Country:US
Mailing Address - Phone:817-477-2525
Mailing Address - Fax:
Practice Address - Street 1:1831 E BROAD ST STE 213
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-9171
Practice Address - Country:US
Practice Address - Phone:817-477-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32115183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist