Provider Demographics
NPI:1578152641
Name:PULEO, JEAN C (BS-RPH)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:C
Last Name:PULEO
Suffix:
Gender:F
Credentials:BS-RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MOUNT VERNON ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-3104
Mailing Address - Country:US
Mailing Address - Phone:603-548-6171
Mailing Address - Fax:
Practice Address - Street 1:300 MOUNT VERNON ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-3104
Practice Address - Country:US
Practice Address - Phone:603-548-6171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHR1527183500000X
MAPH19660183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist