Provider Demographics
NPI:1538491121
Name:ZIMMERMAN, LEONARD (RPH)
Entity Type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:
Last Name:ZIMMERMAN
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 1:3161 BAINBRIDGE AVE
Mailing Address - Street 2:LESELL PHARMACY
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-3907
Mailing Address - Country:US
Mailing Address - Phone:718-547-8888
Mailing Address - Fax:718-405-1877
Practice Address - Street 1:3161 BAINBRIDGE AVE
Practice Address - Street 2:LESELL PHARMACY
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-3907
Practice Address - Country:US
Practice Address - Phone:718-547-8888
Practice Address - Fax:718-405-1877
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032883183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist