Healthcare Provider Details

I. General information

NPI: 1316399835
Provider Name (Legal Business Name): LESLIE MARIE WALTERS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LESLIE WALTERS PERRY PHARMD

II. Dates (important events)

Enumeration Date: 07/08/2016
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 E KELLOGG DR
WICHITA KS
67218-1607
US

IV. Provider business mailing address

5500 E KELLOGG DR
WICHITA KS
67218-1607
US

V. Phone/Fax

Practice location:
  • Phone: 316-685-2221
  • Fax: 316-681-5530
Mailing address:
  • Phone: 316-685-2221
  • Fax: 316-681-5530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number26093
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: