Provider Demographics
NPI:1871898742
Name:MALLON, LESLIE NORWOOD (RPH)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:NORWOOD
Last Name:MALLON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1090
Mailing Address - Street 2:725 COY SMITH HIGHWAY
Mailing Address - City:MOUNT VERNON
Mailing Address - State:AL
Mailing Address - Zip Code:36560-1090
Mailing Address - Country:US
Mailing Address - Phone:251-662-6838
Mailing Address - Fax:251-829-5636
Practice Address - Street 1:725 E COY SMITH HWY
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:AL
Practice Address - Zip Code:36560-3322
Practice Address - Country:US
Practice Address - Phone:251-662-6838
Practice Address - Fax:251-829-5636
Is Sole Proprietor?:No
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL133411835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric