Provider Demographics
NPI:1154585719
Name:LEONARD, GEORGE RENE I (RPH)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:RENE
Last Name:LEONARD
Suffix:I
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 1:2754 PITKIN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-3100
Mailing Address - Country:US
Mailing Address - Phone:718-277-7707
Mailing Address - Fax:
Practice Address - Street 1:2754 PITKIN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-3100
Practice Address - Country:US
Practice Address - Phone:718-277-7707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037434183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY037434OtherPHARMACIST LICENSE NUMBER