Provider Demographics
NPI:1396819777
Name:JOCHEM, COLLEEN LEARY (RPH PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:LEARY
Last Name:JOCHEM
Suffix:
Gender:F
Credentials:RPH PHARM D
Other - Prefix:MISS
Other - First Name:COLLEEN
Other - Middle Name:ELIZABETH
Other - Last Name:LEARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH PHARM D
Mailing Address - Street 1:993 NE ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957
Mailing Address - Country:US
Mailing Address - Phone:772-334-2777
Mailing Address - Fax:772-334-8444
Practice Address - Street 1:2160 SOUTH FEDERAL HIGHWAY
Practice Address - Street 2:WINN DIXIE PHARMACY STORE 307
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994
Practice Address - Country:US
Practice Address - Phone:772-221-3402
Practice Address - Fax:772-221-3505
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS23178183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist