Healthcare Provider Details

I. General information

NPI: 1073790457
Provider Name (Legal Business Name): ELEANOR LEEANN CUPETO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEEANN CUPETO PHARMD

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 02/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11750 SE FEDERAL HWY
HOBE SOUND FL
33455-5303
US

IV. Provider business mailing address

11750 SE FEDERAL HWY
HOBE SOUND FL
33455-5303
US

V. Phone/Fax

Practice location:
  • Phone: 772-456-5666
  • Fax: 772-545-5672
Mailing address:
  • Phone: 772-545-5666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS41480
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: