Healthcare Provider Details

I. General information

NPI: 1891077244
Provider Name (Legal Business Name): LESLIE HURST PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2011
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11391 DECIMAL DR
LOUISVILLE KY
40299-2445
US

IV. Provider business mailing address

11391 DECIMAL DR
LOUISVILLE KY
40299-2445
US

V. Phone/Fax

Practice location:
  • Phone: 502-240-1629
  • Fax: 502-240-1633
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number013266
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: