Provider Demographics
NPI:1225376189
Name:STELTER, JEANNE-MARIE
Entity type:Individual
Prefix:
First Name:JEANNE-MARIE
Middle Name:
Last Name:STELTER
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 1:60 S HOLIDAY RD
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32550-3996
Mailing Address - Country:US
Mailing Address - Phone:850-269-7780
Mailing Address - Fax:850-269-1632
Practice Address - Street 1:60 S HOLIDAY RD
Practice Address - Street 2:
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-3996
Practice Address - Country:US
Practice Address - Phone:850-269-7780
Practice Address - Fax:850-269-1632
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-27
Last Update Date:2013-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS23978183500000X
MSE6189183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist