1215051206 NPI number — MRS. LESLIE HAYES TODD

Table of content: MRS. LESLIE HAYES TODD (NPI 1215051206)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215051206 NPI number — MRS. LESLIE HAYES TODD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TODD
Provider First Name:
LESLIE
Provider Middle Name:
HAYES
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215051206
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2219 MAIN ST
Provider Second Line Business Mailing Address:
RIVERTOWN PHARMACY
Provider Business Mailing Address City Name:
CONWAY
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29526-3340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-488-4400
Provider Business Mailing Address Fax Number:
843-488-4401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2219 MAIN ST
Provider Second Line Business Practice Location Address:
RIVERTOWN PHARMACY
Provider Business Practice Location Address City Name:
CONWAY
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29526-3340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-488-4400
Provider Business Practice Location Address Fax Number:
843-488-4401
Provider Enumeration Date:
03/17/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  7973 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)