Provider Demographics
NPI:1134401037
Name:LESLIE, ZACHARY BRIAN (PHARMD)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:BRIAN
Last Name:LESLIE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 MAKO CT
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4216
Mailing Address - Country:US
Mailing Address - Phone:814-449-2089
Mailing Address - Fax:
Practice Address - Street 1:6300 CRAIN HWY
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-4259
Practice Address - Country:US
Practice Address - Phone:301-392-6116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19718183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist