Provider Demographics
NPI:1235405242
Name:LEONE-LAROSE, JANA BEAU (RPH)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:BEAU
Last Name:LEONE-LAROSE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 SLASH PINE CT
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-1748
Mailing Address - Country:US
Mailing Address - Phone:843-504-7104
Mailing Address - Fax:
Practice Address - Street 1:1021 OAK FOREST LN
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-9795
Practice Address - Country:US
Practice Address - Phone:843-839-6606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-25
Last Update Date:2012-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9849183500000X
CO13578183500000X
VI222183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist