Provider Demographics
NPI:1700507639
Name:MILLER, LESLIE SCOTT
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:SCOTT
Last Name:MILLER
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 1:11001 BLUEGRASS PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-2368
Mailing Address - Country:US
Mailing Address - Phone:502-805-3530
Mailing Address - Fax:
Practice Address - Street 1:11001 BLUEGRASS PKWY STE 200
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-2368
Practice Address - Country:US
Practice Address - Phone:502-805-3530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY013252183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist