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NPI Code Detail

MEDICARE: LENNORA ANN OUELLETTE RPH

MEDICARE: LENNORA ANN OUELLETTE RPH
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
1183500000XPharmacistPS0027652FL

General Provider Information

NPI Number : 1356627574
Entity Type Code : Individual
Provider Name (Legal Business Name) : LENNORA ANN OUELLETTE RPH
Provider Business Mailing Address
First Line : 6333 HOLLYWOOD ST
Second Line :
City : JUPITER
State : FL
Zip : 33458-6781
Country : US
Telephone Number : 561-627-9913
Fax Number :
Provider Business Practice Location Address
First Line : 2501 VIRGINIA AVE
Second Line :
City : FORT PIERCE
State : FL
Zip : 34981-5588
Country : US
Telephone Number : 772-595-3077
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2011
Last Update Date : 11/02/2011

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