Provider Demographics
NPI:1841518537
Name:PROLA, LESLIE ANN
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANN
Last Name:PROLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4534 BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-4745
Mailing Address - Country:US
Mailing Address - Phone:412-373-5420
Mailing Address - Fax:412-374-9620
Practice Address - Street 1:4534 BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-4745
Practice Address - Country:US
Practice Address - Phone:412-373-5420
Practice Address - Fax:412-374-9620
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP039036L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist