Provider Demographics
NPI:1215051206
Name:TODD, LESLIE HAYES
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:HAYES
Last Name:TODD
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 1:2219 MAIN ST
Mailing Address - Street 2:RIVERTOWN PHARMACY
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-3340
Mailing Address - Country:US
Mailing Address - Phone:843-488-4400
Mailing Address - Fax:843-488-4401
Practice Address - Street 1:2219 MAIN ST
Practice Address - Street 2:RIVERTOWN PHARMACY
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-3340
Practice Address - Country:US
Practice Address - Phone:843-488-4400
Practice Address - Fax:843-488-4401
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7973183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist