Provider Demographics
NPI:1669870598
Name:DESIMONE, LESLIE (RPH)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:DESIMONE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:
Other - Last Name:DESIMONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:303 E RUTHERFORD ST
Mailing Address - Street 2:
Mailing Address - City:LANDRUM
Mailing Address - State:SC
Mailing Address - Zip Code:29356-1627
Mailing Address - Country:US
Mailing Address - Phone:864-457-4163
Mailing Address - Fax:
Practice Address - Street 1:303 E RUTHERFORD ST
Practice Address - Street 2:
Practice Address - City:LANDRUM
Practice Address - State:SC
Practice Address - Zip Code:29356-1627
Practice Address - Country:US
Practice Address - Phone:864-457-4163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9492183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist