Basic Information
| Provider Information | |||||||||
| NPI: | 1659777167 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHIRTS | ||||||||
| FirstName: | LESLIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4820 N ROAD 68 | ||||||||
| Address2: | |||||||||
| City: | PASCO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993019009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095497947 | ||||||||
| FaxNumber: | 5095437949 | ||||||||
| Practice Location | |||||||||
| Address1: | 4820 N ROAD 68 | ||||||||
| Address2: | |||||||||
| City: | PASCO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993019009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095497947 | ||||||||
| FaxNumber: | 5095437949 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2014 | ||||||||
| LastUpdateDate: | 11/10/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PH60418728 | WA | Y | Pharmacy Service Providers | Pharmacist | 183500000X | 6999368-1701 | UT | N | Pharmacy Service Providers | Pharmacist |
No ID Information.