Provider Demographics
NPI:1447668504
Name:STAMPER, LESLEY N
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:N
Last Name:STAMPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 OAK DR APT F
Mailing Address - Street 2:
Mailing Address - City:DUNBAR
Mailing Address - State:WV
Mailing Address - Zip Code:25064-1835
Mailing Address - Country:US
Mailing Address - Phone:859-213-1268
Mailing Address - Fax:
Practice Address - Street 1:104 OAK DR APT F
Practice Address - Street 2:
Practice Address - City:DUNBAR
Practice Address - State:WV
Practice Address - Zip Code:25064-1835
Practice Address - Country:US
Practice Address - Phone:859-213-1268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0008704183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist