Provider Demographics
NPI:1699816785
Name:LESLIE, GLENN E (RPH)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:E
Last Name:LESLIE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 RAINBOW DR
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5309
Mailing Address - Country:US
Mailing Address - Phone:256-547-4479
Mailing Address - Fax:256-549-0577
Practice Address - Street 1:911 RAINBOW DR
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5309
Practice Address - Country:US
Practice Address - Phone:256-547-4479
Practice Address - Fax:256-549-0577
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11682183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist