Basic Information
| Provider Information | |||||||||
| NPI: | 1942827068 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARLISLE | ||||||||
| FirstName: | LEAH | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40 WALDEN CIR | ||||||||
| Address2: | |||||||||
| City: | SUMTER | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291548135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8039835960 | ||||||||
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| Practice Location | |||||||||
| Address1: | 615 BULTMAN DR | ||||||||
| Address2: | |||||||||
| City: | SUMTER | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291502514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8033056194 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2020 | ||||||||
| LastUpdateDate: | 07/06/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 42519 | SC | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.