Provider Demographics
NPI:1780874420
Name:CHENEY, LESLIE ELIAS (RPH)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:ELIAS
Last Name:CHENEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:569 LAKE COLONY DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-7409
Mailing Address - Country:US
Mailing Address - Phone:205-967-3006
Mailing Address - Fax:205-967-3006
Practice Address - Street 1:1936 OLD ORCHARD ROAD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35216-2247
Practice Address - Country:US
Practice Address - Phone:205-824-0775
Practice Address - Fax:205-313-5791
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14543183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist