Provider Demographics
NPI:1295836435
Name:LADINO, JEANETTE
Entity Type:Individual
Prefix:MS
First Name:JEANETTE
Middle Name:
Last Name:LADINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 FENTON DR
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-3555
Mailing Address - Country:US
Mailing Address - Phone:561-637-6077
Mailing Address - Fax:
Practice Address - Street 1:14595 MILITARY TRL
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-3730
Practice Address - Country:US
Practice Address - Phone:561-637-2364
Practice Address - Fax:561-637-2876
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS32669183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist