Provider Demographics
NPI:1285073247
Name:BURGESS, LESLIE JEAN (PHARMD)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:JEAN
Last Name:BURGESS
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 1:1260 UNION ST S
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-5810
Mailing Address - Country:US
Mailing Address - Phone:704-793-1629
Mailing Address - Fax:704-795-7024
Practice Address - Street 1:1260 UNION ST S
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-5810
Practice Address - Country:US
Practice Address - Phone:704-793-1629
Practice Address - Fax:704-795-7024
Is Sole Proprietor?:No
Enumeration Date:2013-06-22
Last Update Date:2013-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18078183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist