Basic Information
| Provider Information | |||||||||
| NPI: | 1972067684 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARKER | ||||||||
| FirstName: | LESLIE | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20015 MERINDA LN | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395604301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2283428465 | ||||||||
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| Practice Location | |||||||||
| Address1: | 400 VETERANS AVE | ||||||||
| Address2: | |||||||||
| City: | BILOXI | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395312410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2285235000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2019 | ||||||||
| LastUpdateDate: | 01/27/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P0018X | E-09270 | MS | Y | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
No ID Information.