Provider Demographics
NPI:1992305577
Name:WILLIAMS, LESLIE SMITH (PHARMACIST)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:SMITH
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11488 HIGHWAY 503
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:MS
Mailing Address - Zip Code:39332-3331
Mailing Address - Country:US
Mailing Address - Phone:601-917-2422
Mailing Address - Fax:
Practice Address - Street 1:231 EASTSIDE DR
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MS
Practice Address - Zip Code:39345-8035
Practice Address - Country:US
Practice Address - Phone:601-683-3640
Practice Address - Fax:601-683-3640
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS010886183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist