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NPI Code Detail

MEDICARE: LESLIE A. PROCTOR PHARM.D, BCPS

MEDICARE: LESLIE A. PROCTOR PHARM.D, BCPS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11835P1200XPharmacotherapy Pharmacist15464NC
21835P1200XPharmacotherapy Pharmacist10042SC

General Provider Information

NPI Number : 1467438663
Entity Type Code : Individual
Provider Name (Legal Business Name) : LESLIE A. PROCTOR PHARM.D, BCPS
Provider Business Mailing Address
First Line : 117 MAJESTIC CT
Second Line :
City : LEXINGTON
State : SC
Zip : 29072-6962
Country : US
Telephone Number : 803-542-0197
Fax Number :
Provider Business Practice Location Address
First Line : 6439 GARNERS FERRY RD
Second Line : ATTN: PHARMACY DEPT
City : COLUMBIA
State : SC
Zip : 29209-1638
Country : US
Telephone Number : 803-528-4830
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2005
Last Update Date : 07/01/2016

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