MEDICARE: LEONAUM PHARMACY INC.

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	3336C0003X	Community/Retail Pharmacy	026314	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124034640
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEONAUM PHARMACY INC.

Provider Business Mailing Address
First Line	:	4910 FORT HAMILTON PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-3344
Country	:	US
Telephone Number	:	718-437-4699
Fax Number	:	718-437-0796

Provider Business Practice Location Address
First Line	:	4910 FORT HAMILTON PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-3344
Country	:	US
Telephone Number	:	718-437-4699
Fax Number	:	718-437-0796

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROMAN PINHASOV
Credential	:
Telephone Number	:	718-437-4699

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	02/23/2022

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