Individual
DR. LESLIE BLAYLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
817 W MAIN ST, TUPELO, MS 38801-3630
(662) 620-7959
Mailing address
817 W MAIN ST, TUPELO, MS 38801-3630
(662) 620-7959
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
E-07703
MS
Other
Enumeration date
08/26/2020
Last updated
08/26/2020
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