Provider Demographics
NPI:1932188018
Name:HINES, LESLEY NICOLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LESLEY
Middle Name:NICOLE
Last Name:HINES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3002 SUMMER MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19518-1320
Mailing Address - Country:US
Mailing Address - Phone:610-385-1107
Mailing Address - Fax:
Practice Address - Street 1:NAVAL HEALTH CLINIC, BLDG 137
Practice Address - Street 2:NAVAL AIR STATION JOINT RESERVE BASE WILLOW GROVE
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090
Practice Address - Country:US
Practice Address - Phone:215-773-2402
Practice Address - Fax:215-773-2409
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00051701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist