Provider Demographics
NPI:1437330149
Name:ROSOKOFF, LEONARD NORMAN (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:NORMAN
Last Name:ROSOKOFF
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 NIIAGARA STREET TONAWANDA NY 14150
Mailing Address - Street 2:
Mailing Address - City:TONAWNADA
Mailing Address - State:NY
Mailing Address - Zip Code:14150
Mailing Address - Country:US
Mailing Address - Phone:716-692-3932
Mailing Address - Fax:716-692-7704
Practice Address - Street 1:47 NIIAGARA STREET TONAWANDA NY 14150
Practice Address - Street 2:
Practice Address - City:TONAWNADA
Practice Address - State:NY
Practice Address - Zip Code:14150
Practice Address - Country:US
Practice Address - Phone:716-692-3932
Practice Address - Fax:716-692-7704
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023204183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00730341Medicaid