Healthcare Provider Details

I. General information

NPI: 1982940102
Provider Name (Legal Business Name): PAULA LESLIE WAKELAND RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PAULA L WAKELAND-HEWITT RPH

II. Dates (important events)

Enumeration Date: 12/15/2012
Last Update Date: 12/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5124 OCEAN BLVD
SARASOTA FL
34242-1637
US

IV. Provider business mailing address

5426 SHADOW LAWN DR
SARASOTA FL
34242-1833
US

V. Phone/Fax

Practice location:
  • Phone: 941-349-1111
  • Fax: 941-312-0631
Mailing address:
  • Phone: 941-346-0797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS30617
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: