Provider Demographics
NPI:1659686160
Name:LEBRUN, RONY M
Entity Type:Individual
Prefix:
First Name:RONY
Middle Name:M
Last Name:LEBRUN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 S SHORE RD
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:MA
Mailing Address - Zip Code:02343-1683
Mailing Address - Country:US
Mailing Address - Phone:781-986-6801
Mailing Address - Fax:
Practice Address - Street 1:119 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1728
Practice Address - Country:US
Practice Address - Phone:781-878-3835
Practice Address - Fax:787-878-6084
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH23460183500000X
NH3063183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist