MEDICARE: JEAN C PULEO BS-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
1	183500000X	Pharmacist	R1527	NH
2	183500000X	Pharmacist	PH19660	MA

General Provider Information

NPI Number	:	1578152641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN C PULEO BS-RPH

Provider Business Mailing Address
First Line	:	300 MOUNT VERNON ST
Second Line	:
City	:	LAWRENCE
State	:	MA
Zip	:	01843-3104
Country	:	US
Telephone Number	:	603-548-6171
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 MOUNT VERNON ST
Second Line	:
City	:	LAWRENCE
State	:	MA
Zip	:	01843-3104
Country	:	US
Telephone Number	:	603-548-6171
Fax Number	:

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

Provider Enumeration Date	:	01/13/2021
Last Update Date	:	01/13/2021

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