Provider Demographics
NPI:1740592070
Name:LESLIE, RYAN (PHARM D)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:LESLIE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 CONQUEST STE H
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-0227
Mailing Address - Country:US
Mailing Address - Phone:956-305-6767
Mailing Address - Fax:956-305-6768
Practice Address - Street 1:230 CONQUEST STE H
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-0227
Practice Address - Country:US
Practice Address - Phone:956-305-6767
Practice Address - Fax:956-305-6768
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45695183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist