Provider Demographics
NPI:1891060455
Name:SPITALE, LEONARD A (RPH)
Entity Type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:A
Last Name:SPITALE
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 1:1250 OLD COUNTRY RD
Mailing Address - Street 2:COSTCO PHARMACY
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-5624
Mailing Address - Country:US
Mailing Address - Phone:516-683-8801
Mailing Address - Fax:516-593-1222
Practice Address - Street 1:1250 OLD COUNTRY RD
Practice Address - Street 2:COSTCO PHARMACY
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-5624
Practice Address - Country:US
Practice Address - Phone:516-683-8801
Practice Address - Fax:516-593-1222
Is Sole Proprietor?:No
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033866183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist