Provider Demographics
NPI:1427516483
Name:HOUSTON, LESLIE ANDERSON (RPH)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANDERSON
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 N BELTLINE DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-7403
Mailing Address - Country:US
Mailing Address - Phone:434-664-0909
Mailing Address - Fax:
Practice Address - Street 1:230 N BELTLINE DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-7403
Practice Address - Country:US
Practice Address - Phone:434-664-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6995183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC6995OtherPHARMACIST LICENSE