Provider Demographics
NPI:1497012645
Name:GRAZUL, LEON JR (RPH)
Entity Type:Individual
Prefix:
First Name:LEON
Middle Name:
Last Name:GRAZUL
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 ROCKLEDGE RD
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-4335
Mailing Address - Country:US
Mailing Address - Phone:973-584-4466
Mailing Address - Fax:973-584-4648
Practice Address - Street 1:2 ROXBURY MALL STRIP
Practice Address - Street 2:SHOP RITE PHARMACY
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876
Practice Address - Country:US
Practice Address - Phone:973-584-4466
Practice Address - Fax:973-584-4648
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01587400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI01587400OtherSTATE LICENSE