Provider Demographics
NPI:1528668266
Name:STOOTS, LESKA (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:LESKA
Middle Name:
Last Name:STOOTS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1193 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-4121
Mailing Address - Country:US
Mailing Address - Phone:276-783-6656
Mailing Address - Fax:276-783-6769
Practice Address - Street 1:1193 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-4121
Practice Address - Country:US
Practice Address - Phone:276-783-6656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202209393183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist