Provider Demographics
NPI:1528248879
Name:WAITE, LEONARD A (RPH)
Entity type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:A
Last Name:WAITE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 ANTHONY DR
Mailing Address - Street 2:
Mailing Address - City:FORT EDWARD
Mailing Address - State:NY
Mailing Address - Zip Code:12828-1632
Mailing Address - Country:US
Mailing Address - Phone:518-747-4886
Mailing Address - Fax:
Practice Address - Street 1:32 ANTHONY DR
Practice Address - Street 2:
Practice Address - City:FORT EDWARD
Practice Address - State:NY
Practice Address - Zip Code:12828-1632
Practice Address - Country:US
Practice Address - Phone:518-747-4886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-04
Last Update Date:2007-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027181183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist