Healthcare Provider Details

I. General information

NPI: 1316876451
Provider Name (Legal Business Name): LEENA BARDWAJ MENON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 STONEWALL RD
SALEM CT
06420-4135
US

IV. Provider business mailing address

101 STONEWALL RD
SALEM CT
06420-4135
US

V. Phone/Fax

Practice location:
  • Phone: 860-997-1613
  • Fax:
Mailing address:
  • Phone: 860-997-1613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9963
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: