Provider Demographics
NPI:1043501695
Name:LESPERANCE, MARY HELENA (PHARMACIST (RPH))
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:HELENA
Last Name:LESPERANCE
Suffix:
Gender:F
Credentials:PHARMACIST (RPH)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7960 US HWY 1
Mailing Address - Street 2:
Mailing Address - City:MICCO
Mailing Address - State:FL
Mailing Address - Zip Code:32976
Mailing Address - Country:US
Mailing Address - Phone:772-663-1135
Mailing Address - Fax:772-663-1133
Practice Address - Street 1:7960 US HWY 1
Practice Address - Street 2:
Practice Address - City:MICCO
Practice Address - State:FL
Practice Address - Zip Code:32976
Practice Address - Country:US
Practice Address - Phone:772-663-1135
Practice Address - Fax:772-663-1133
Is Sole Proprietor?:No
Enumeration Date:2011-04-29
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS47142183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist