Provider Demographics
NPI:1255019105
Name:STEPHAN, LESLEY RAE (PHARMD)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:RAE
Last Name:STEPHAN
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 1:5014 CAMERON RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-3903
Mailing Address - Country:US
Mailing Address - Phone:205-249-6919
Mailing Address - Fax:
Practice Address - Street 1:2100 RIVERCHASE CTR STE 308
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-1853
Practice Address - Country:US
Practice Address - Phone:205-994-7103
Practice Address - Fax:205-588-0255
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11833183500000X, 1835C0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835C0207XPharmacy Service ProvidersPharmacistCompounded Sterile Preparations
No183500000XPharmacy Service ProvidersPharmacist