Healthcare Provider Details

I. General information

NPI: 1316145626
Provider Name (Legal Business Name): LESLEY B RINE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2007
Last Update Date: 10/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4750 E 450 S
WHITESTOWN IN
46075-8404
US

IV. Provider business mailing address

4750 E 450 S
WHITESTOWN IN
46075-8404
US

V. Phone/Fax

Practice location:
  • Phone: 877-732-3431
  • Fax: 317-768-7927
Mailing address:
  • Phone: 877-732-3431
  • Fax: 317-768-7927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26985
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: