MEDICARE: LEONID KUPERSHMIDT PHARMACIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	041803	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	022434	OTHER	NY	STATE PHARMACY LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548321110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONID KUPERSHMIDT PHARMACIST

Provider Business Mailing Address
First Line	:	4701 QUEENS BLVD
Second Line	:
City	:	SUNNYSIDE
State	:	NY
Zip	:	11104-1660
Country	:	US
Telephone Number	:	718-482-8900
Fax Number	:	718-482-8901

Provider Business Practice Location Address
First Line	:	4701 QUEENS BLVD
Second Line	:
City	:	SUNNYSIDE
State	:	NY
Zip	:	11104-1660
Country	:	US
Telephone Number	:	718-482-8900
Fax Number	:	718-482-8901

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	01/06/2026

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