Provider Demographics
NPI:1417146861
Name:GARNEAU, PAUL LEON (RPH,)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:LEON
Last Name:GARNEAU
Suffix:
Gender:M
Credentials:RPH,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9981 S HEALTHPARK DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-3618
Mailing Address - Country:US
Mailing Address - Phone:239-343-5100
Mailing Address - Fax:239-985-3880
Practice Address - Street 1:1517 HONOR CT
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-2036
Practice Address - Country:US
Practice Address - Phone:239-565-1734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0025805183500000X, 1835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835N1003XPharmacy Service ProvidersPharmacistNutrition Support