Provider Demographics
NPI:1447610050
Name:HARNISH, LESLIE MARIE (RPH)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:MARIE
Last Name:HARNISH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:LESLIE
Other - Middle Name:MARIE
Other - Last Name:ZADECKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:8405 BAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-9524
Mailing Address - Country:US
Mailing Address - Phone:610-334-0888
Mailing Address - Fax:
Practice Address - Street 1:4300 NC HIGHWAY 49 S
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-7527
Practice Address - Country:US
Practice Address - Phone:704-455-6420
Practice Address - Fax:704-454-5124
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24864183500000X
PARP040997L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist