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General NPI Number Information
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NPI Number | 1053698308
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Entity Type | Individual
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Provider Name | LESLIE NICHOLE BONNER PHARMD
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Gender | Female
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Dates
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Enumeration Date | 11/14/2011
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Last Update Date | 11/14/2011
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Provider Practice Location Address
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Address Line | 668 LOMB AVE SW
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City | BIRMINGHAM
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State | AL
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Zip | 35211-1330
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Country | US
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Telephone | 205-786-4481
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Fax | 205-786-6847
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Provider Business Mailing Address
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Address Line | 1343 MOUNTAIN LN
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City | GARDENDALE
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State | AL
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Zip | 35071-4201
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Country | US
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Telephone | 205-786-4481
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Fax | 205-786-6847
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 14551
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License Number State | AL
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