Provider Demographics
NPI:1699959601
Name:LEERET, STEPHEN
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:LEERET
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6272 STATE ROUTE 9
Mailing Address - Street 2:
Mailing Address - City:CHESTERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12817
Mailing Address - Country:US
Mailing Address - Phone:518-494-3211
Mailing Address - Fax:
Practice Address - Street 1:6272 STATE RTE 9
Practice Address - Street 2:
Practice Address - City:CHESTERTOWN
Practice Address - State:NY
Practice Address - Zip Code:12817
Practice Address - Country:US
Practice Address - Phone:518-494-3211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY29566183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist