Provider Demographics
NPI:1194138107
Name:LESLIE, JOHN (PHARMD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:LESLIE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST PALESTINE
Mailing Address - State:OH
Mailing Address - Zip Code:44413
Mailing Address - Country:US
Mailing Address - Phone:330-426-9291
Mailing Address - Fax:
Practice Address - Street 1:25 W MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST PALESTINE
Practice Address - State:OH
Practice Address - Zip Code:44413
Practice Address - Country:US
Practice Address - Phone:330-426-9291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-06
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03331206183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist