MEDICARE: LESLIE ANN PROLA

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
1	183500000X	Pharmacist	RP039036L	PA

General Provider Information

NPI Number	:	1841518537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE ANN PROLA

Provider Business Mailing Address
First Line	:	4534 BROADWAY BLVD
Second Line	:
City	:	MONROEVILLE
State	:	PA
Zip	:	15146-4745
Country	:	US
Telephone Number	:	412-373-5420
Fax Number	:	412-374-9620

Provider Business Practice Location Address
First Line	:	4534 BROADWAY BLVD
Second Line	:
City	:	MONROEVILLE
State	:	PA
Zip	:	15146-4745
Country	:	US
Telephone Number	:	412-373-5420
Fax Number	:	412-374-9620

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2010
Last Update Date	:	05/06/2010

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Directions to “ LESLIE ANN PROLA ” Practice Location

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