Provider Demographics
NPI:1144308404
Name:MUDD, LESLIE B (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:B
Last Name:MUDD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
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Mailing Address - Street 1:1822 BOONE TRL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-4402
Mailing Address - Country:US
Mailing Address - Phone:502-561-7423
Mailing Address - Fax:502-561-7385
Practice Address - Street 1:530 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1675
Practice Address - Country:US
Practice Address - Phone:502-561-7423
Practice Address - Fax:502-561-7385
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY75661835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology