Provider Demographics
NPI:1457574402
Name:BARRANT, JACQUELINE LENETTE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:LENETTE
Last Name:BARRANT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 ELLISON AVE
Mailing Address - Street 2:
Mailing Address - City:MATTAPAN
Mailing Address - State:MA
Mailing Address - Zip Code:02126-2804
Mailing Address - Country:US
Mailing Address - Phone:617-298-1920
Mailing Address - Fax:617-298-7027
Practice Address - Street 1:4600 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-4832
Practice Address - Country:US
Practice Address - Phone:617-323-3823
Practice Address - Fax:617-323-1291
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23206183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist