Provider Demographics
NPI:1013205681
Name:BOHNER, LESLIE NICOLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:NICOLE
Last Name:BOHNER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1852 LOMITA BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-1968
Mailing Address - Country:US
Mailing Address - Phone:310-539-1750
Mailing Address - Fax:310-539-1734
Practice Address - Street 1:1852 LOMITA BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-1968
Practice Address - Country:US
Practice Address - Phone:310-539-1750
Practice Address - Fax:310-539-1734
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66208183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist