Provider Demographics
NPI:1134397011
Name:BIRDWELL, LESLEY M (PHARM D)
Entity type:Individual
Prefix:DR
First Name:LESLEY
Middle Name:M
Last Name:BIRDWELL
Suffix:
Gender:F
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:PSC 80 BOX 10237
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:US
Mailing Address - Zip Code:96367
Mailing Address - Country:US
Mailing Address - Phone:098-958-7288
Mailing Address - Fax:
Practice Address - Street 1:PSC 80 BOX 10237
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:US
Practice Address - Zip Code:96367
Practice Address - Country:US
Practice Address - Phone:098-958-7288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13102183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist