Provider Demographics
NPI:1043593692
Name:JONKER, LELANIE (BPHARM)
Entity Type:Individual
Prefix:
First Name:LELANIE
Middle Name:
Last Name:JONKER
Suffix:
Gender:F
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3180 SE FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-5531
Mailing Address - Country:US
Mailing Address - Phone:772-288-6468
Mailing Address - Fax:772-288-7254
Practice Address - Street 1:3180 SE FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-5531
Practice Address - Country:US
Practice Address - Phone:772-288-6468
Practice Address - Fax:772-288-7254
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43456183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist