Provider Demographics
NPI:1053915231
Name:WELLS, LESLIE DEANN (PHARMD)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:DEANN
Last Name:WELLS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1074 N AVON AVE
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-8863
Mailing Address - Country:US
Mailing Address - Phone:317-272-2133
Mailing Address - Fax:
Practice Address - Street 1:1074 N AVON AVE
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-8863
Practice Address - Country:US
Practice Address - Phone:317-272-2133
Practice Address - Fax:317-272-5061
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-28
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019808A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist