Provider Demographics
NPI:1740564756
Name:SUCKNEY, LESLIE (RPH)
Entity type:Individual
Prefix:MR
First Name:LESLIE
Middle Name:
Last Name:SUCKNEY
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 1:266 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-4922
Mailing Address - Country:US
Mailing Address - Phone:781-235-1464
Mailing Address - Fax:781-239-0971
Practice Address - Street 1:266 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-4922
Practice Address - Country:US
Practice Address - Phone:781-235-1464
Practice Address - Fax:781-239-0971
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH14544183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist