Provider Demographics
NPI:1861896698
Name:HODGE, LESLIE (PHARMD)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:HODGE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:
Other - Last Name:TINDAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:PO BOX 29517
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-0517
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1965 N STATE ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-1089
Practice Address - Country:US
Practice Address - Phone:317-462-4241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-22
Last Update Date:2017-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021532A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist