MEDICARE: RUBEN A LEON RPH

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	042317	NY

General Provider Information

NPI Number	:	1215053657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUBEN A LEON RPH

Provider Business Mailing Address
First Line	:	1805 5TH AVE
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-1761
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1805 5TH AVE
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-1761
Country	:	US
Telephone Number	:	631-231-4960
Fax Number	:

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

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	07/08/2007

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