Provider Demographics
NPI:1801171616
Name:ZGORSKI, LEONARD J (RPH)
Entity type:Individual
Prefix:
First Name:LEONARD
Middle Name:J
Last Name:ZGORSKI
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 1:302 CANDEWYCK DR
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-5258
Mailing Address - Country:US
Mailing Address - Phone:860-667-1887
Mailing Address - Fax:
Practice Address - Street 1:4 HAMMERHEAD PLACE
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416
Practice Address - Country:US
Practice Address - Phone:860-613-2324
Practice Address - Fax:860-613-2364
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00004498183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist