Provider Demographics
NPI:1891026977
Name:GREENBAUM, LEON (RPH)
Entity Type:Individual
Prefix:MR
First Name:LEON
Middle Name:
Last Name:GREENBAUM
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 1:10 CHRISTIE DR
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-5405
Mailing Address - Country:US
Mailing Address - Phone:845-368-9700
Mailing Address - Fax:845-368-4056
Practice Address - Street 1:296 ROUTE 59
Practice Address - Street 2:
Practice Address - City:TALLMAN
Practice Address - State:NY
Practice Address - Zip Code:10982
Practice Address - Country:US
Practice Address - Phone:845-368-9700
Practice Address - Fax:845-368-4056
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030483183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist