Provider Demographics
NPI:1912393042
Name:FLENIKEN, LEO ENNIS III (PD)
Entity Type:Individual
Prefix:
First Name:LEO
Middle Name:ENNIS
Last Name:FLENIKEN
Suffix:III
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 STRATMORE DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-3019
Mailing Address - Country:US
Mailing Address - Phone:318-455-8255
Mailing Address - Fax:
Practice Address - Street 1:3045 E TEXAS ST
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-3207
Practice Address - Country:US
Practice Address - Phone:318-741-1776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-15
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9549183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist