Provider Demographics
NPI:1457744856
Name:SPENCER, LESLEY EURA (PHARM D)
Entity Type:Individual
Prefix:MISS
First Name:LESLEY
Middle Name:EURA
Last Name:SPENCER
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 1:203 RUE ST DENIS
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-3010
Mailing Address - Country:US
Mailing Address - Phone:228-324-5973
Mailing Address - Fax:
Practice Address - Street 1:2433 25TH AVE
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-4525
Practice Address - Country:US
Practice Address - Phone:228-865-7293
Practice Address - Fax:228-865-3987
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-010530183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist