Provider Demographics
NPI:1245729052
Name:HUGHES, LESA (PHARMD)
Entity type:Individual
Prefix:
First Name:LESA
Middle Name:
Last Name:HUGHES
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 1:1 MYER ST
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37030-1174
Mailing Address - Country:US
Mailing Address - Phone:615-735-3124
Mailing Address - Fax:615-735-3126
Practice Address - Street 1:1 MYER STREET
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:TN
Practice Address - Zip Code:37030
Practice Address - Country:US
Practice Address - Phone:615-735-3124
Practice Address - Fax:615-735-3126
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12065183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN12065OtherPHARMACIST LICENSE NUMBER