Healthcare Provider Details

I. General information

NPI: 1437087988
Provider Name (Legal Business Name): LESLIE BONES MACLAY BSPHARM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 TOWN CENTER PKWY
RESTON VA
20190-3298
US

IV. Provider business mailing address

21320 SMALL BRANCH PL
BROADLANDS VA
20148-4007
US

V. Phone/Fax

Practice location:
  • Phone: 703-689-9035
  • Fax:
Mailing address:
  • Phone: 703-689-9035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number0202009369
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: