Provider Demographics
NPI:1700169463
Name:CARR, LESLIE RICHARD
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:RICHARD
Last Name:CARR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5840 BROOKFLOWER CIRCLE LN
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-0293
Mailing Address - Country:US
Mailing Address - Phone:337-479-1824
Mailing Address - Fax:
Practice Address - Street 1:5840 BROOKFLOWER CIRCLE LN
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-0293
Practice Address - Country:US
Practice Address - Phone:337-479-1824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0092291835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist