MEDICARE: MS. MARY HELENA LESPERANCE PHARMACIST (R.PH.)

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	PS47142	FL

General Provider Information

NPI Number	:	1043501695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY HELENA LESPERANCE PHARMACIST (R.PH.)

Provider Business Mailing Address
First Line	:	7960 US HWY 1
Second Line	:
City	:	MICCO
State	:	FL
Zip	:	32976
Country	:	US
Telephone Number	:	772-663-1135
Fax Number	:	772-663-1133

Provider Business Practice Location Address
First Line	:	7960 US HWY 1
Second Line	:
City	:	MICCO
State	:	FL
Zip	:	32976
Country	:	US
Telephone Number	:	772-663-1135
Fax Number	:	772-663-1133

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

Provider Enumeration Date	:	04/29/2011
Last Update Date	:	04/29/2011

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