Provider Demographics
NPI:1649781865
Name:HESTER, JOLENE
Entity type:Individual
Prefix:
First Name:JOLENE
Middle Name:
Last Name:HESTER
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 1:62 LISA LN
Mailing Address - Street 2:
Mailing Address - City:UNCASVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06382-1408
Mailing Address - Country:US
Mailing Address - Phone:860-861-4306
Mailing Address - Fax:
Practice Address - Street 1:79 STONINGTON RD
Practice Address - Street 2:
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-2931
Practice Address - Country:US
Practice Address - Phone:860-536-5835
Practice Address - Fax:860-536-5837
Is Sole Proprietor?:No
Enumeration Date:2017-10-15
Last Update Date:2017-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0007558183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist