Provider Demographics
NPI:1538371489
Name:BREWER, LESLIE DAVID (PHARMD)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:DAVID
Last Name:BREWER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 PEMBERTON TRACE CT
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33565-5593
Mailing Address - Country:US
Mailing Address - Phone:813-763-1366
Mailing Address - Fax:813-659-3907
Practice Address - Street 1:8800 HIDDEN RIVER PKWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33637-1028
Practice Address - Country:US
Practice Address - Phone:813-903-2039
Practice Address - Fax:813-635-4302
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34680183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS34680OtherPHARMACIST LICENSE