Provider Demographics
NPI:1902187925
Name:LEUNG, NICOLE V (RPH)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:V
Last Name:LEUNG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:V
Other - Last Name:NONATO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:135 S LIBERTY DR
Mailing Address - Street 2:
Mailing Address - City:STONY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10980-2422
Mailing Address - Country:US
Mailing Address - Phone:845-786-2063
Mailing Address - Fax:845-429-5379
Practice Address - Street 1:135 S LIBERTY DR
Practice Address - Street 2:
Practice Address - City:STONY POINT
Practice Address - State:NY
Practice Address - Zip Code:10980-2422
Practice Address - Country:US
Practice Address - Phone:845-786-2063
Practice Address - Fax:845-429-5379
Is Sole Proprietor?:No
Enumeration Date:2011-09-03
Last Update Date:2023-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02509000183500000X
NY046019183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist