LEONARD JAY FAGEN

SOUTHAMPTON, NY
NPI1942522776
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy183500000X Pharmacist
(Licence: NY  26998)
Additional Taxonomies1835P0018X Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
(Licence: NY  26998)
Enumeration Date2010-02-21
Last Update Date2010-02-21
Business Address
-- LEONARD JAY FAGEN rph
111 MAIN ST
SOUTHAMPTON, NY 11968-4810
Phone number: 631-283-4250
Mailing Address
-- LEONARD JAY FAGEN rph
50 ROY DR
NESCONSET, NY 11767-2227
Phone number: 631-360-0236