Provider Demographics
NPI:1154952919
Name:COATS, LESLIE SUZANNE
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:SUZANNE
Last Name:COATS
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 1:5604 SOUTHWEST PKWY APT 3213
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-6276
Mailing Address - Country:US
Mailing Address - Phone:817-995-8267
Mailing Address - Fax:
Practice Address - Street 1:2409 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78712-1112
Practice Address - Country:US
Practice Address - Phone:817-995-8267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy