Provider Demographics
NPI:1710471131
Name:LEPELEY LEBRON, LORENA INES
Entity Type:Individual
Prefix:
First Name:LORENA
Middle Name:INES
Last Name:LEPELEY LEBRON
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 1:1380 BERLIN TPKE
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-1093
Mailing Address - Country:US
Mailing Address - Phone:860-956-3740
Mailing Address - Fax:860-956-0830
Practice Address - Street 1:1380 BERLIN TPKE
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-1093
Practice Address - Country:US
Practice Address - Phone:860-956-3740
Practice Address - Fax:860-956-0830
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0010446183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist