Provider Demographics
NPI:1265893143
Name:CUSHMAN, LEON (RPH)
Entity type:Individual
Prefix:
First Name:LEON
Middle Name:
Last Name:CUSHMAN
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 1:1168 WHALLEY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515-1705
Mailing Address - Country:US
Mailing Address - Phone:203-389-4714
Mailing Address - Fax:203-387-4476
Practice Address - Street 1:1168 WHALLEY AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06515-1705
Practice Address - Country:US
Practice Address - Phone:203-389-4714
Practice Address - Fax:203-387-4476
Is Sole Proprietor?:No
Enumeration Date:2016-03-18
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT0005152183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist