Provider Demographics
NPI:1871661363
Name:JEAN-MARY, CHESNEL (RPH)
Entity Type:Individual
Prefix:
First Name:CHESNEL
Middle Name:
Last Name:JEAN-MARY
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 1:1874 MARYSVILLE DR
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-6607
Mailing Address - Country:US
Mailing Address - Phone:386-956-5386
Mailing Address - Fax:386-574-2562
Practice Address - Street 1:901 N WOODLAND BLVD
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-2734
Practice Address - Country:US
Practice Address - Phone:386-734-5822
Practice Address - Fax:386-738-2783
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS29123183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist