MEDICARE: LESLIE RAQUEL LITTLE PHARMD

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	012332	KY

General Provider Information

NPI Number	:	1942897798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE RAQUEL LITTLE PHARMD

Provider Business Mailing Address
First Line	:	509 FARMINGTON CT
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-2272
Country	:	US
Telephone Number	:	859-576-3652
Fax Number	:

Provider Business Practice Location Address
First Line	:	402 RICHMOND RD N
Second Line	:
City	:	BEREA
State	:	KY
Zip	:	40403-1133
Country	:	US
Telephone Number	:	859-986-4521
Fax Number	:

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

Provider Enumeration Date	:	12/28/2020
Last Update Date	:	12/28/2020

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