Provider Demographics
NPI:1073021655
Name:LETTUNICH, JOLENE (PHARM D)
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:
Last Name:LETTUNICH
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9428 DYER ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79924-6408
Mailing Address - Country:US
Mailing Address - Phone:915-751-4415
Mailing Address - Fax:915-751-5156
Practice Address - Street 1:9428 DYER ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-6408
Practice Address - Country:US
Practice Address - Phone:915-751-4415
Practice Address - Fax:915-751-5156
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59107183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist