Provider Demographics
NPI:1508180589
Name:KOTT, LEONARD BRUCE (RPH)
Entity Type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:BRUCE
Last Name:KOTT
Suffix:
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 1:105 ROY ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-1629
Mailing Address - Country:US
Mailing Address - Phone:516-420-8481
Mailing Address - Fax:516-420-8481
Practice Address - Street 1:790 PARK PL
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2111
Practice Address - Country:US
Practice Address - Phone:516-536-0800
Practice Address - Fax:516-889-8225
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-20
Last Update Date:2010-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033015183500000X
CTPCT.0005685183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist