Provider Demographics
NPI:1255602488
Name:LUNDQUIST, JO ANNE (PHARM D)
Entity type:Individual
Prefix:
First Name:JO ANNE
Middle Name:
Last Name:LUNDQUIST
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 JAMAICA CT
Mailing Address - Street 2:
Mailing Address - City:MARCO ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34145-4045
Mailing Address - Country:US
Mailing Address - Phone:239-394-7311
Mailing Address - Fax:
Practice Address - Street 1:12784 TAMIAMI TRL E
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34113-8453
Practice Address - Country:US
Practice Address - Phone:239-530-1356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS38229183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist