Provider Demographics
NPI:1215534110
Name:LEBLANC, BERNADETTE JEAN (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:BERNADETTE
Middle Name:JEAN
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:BERNADETTE
Other - Middle Name:JEAN
Other - Last Name:WEITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:596 BACK NINE DR
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-4546
Mailing Address - Country:US
Mailing Address - Phone:860-904-0456
Mailing Address - Fax:
Practice Address - Street 1:1214 E VENICE AVE STE C
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-7165
Practice Address - Country:US
Practice Address - Phone:941-584-2080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-04
Last Update Date:2020-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS60635183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist