Provider Demographics
NPI:1952776882
Name:CAMERON, LESLEY ANN (PHARMD)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:ANN
Last Name:CAMERON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-4005
Mailing Address - Country:US
Mailing Address - Phone:517-817-0378
Mailing Address - Fax:
Practice Address - Street 1:1700 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-4005
Practice Address - Country:US
Practice Address - Phone:517-817-0378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302038174183500000X
MST13197183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist