Provider Demographics
NPI:1811432008
Name:NKANSAH, LESLIE (PHARMD)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:NKANSAH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MRS
Other - First Name:LESLIE
Other - Middle Name:NKANSAH
Other - Last Name:BAWUAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:367 ELLENWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709
Mailing Address - Country:US
Mailing Address - Phone:703-599-3772
Mailing Address - Fax:
Practice Address - Street 1:367 ELLENWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709
Practice Address - Country:US
Practice Address - Phone:703-599-3772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-27
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0004397183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist