Provider Demographics
NPI:1831864644
Name:JELLO, FLORENCE FRANCES
Entity type:Individual
Prefix:
First Name:FLORENCE
Middle Name:FRANCES
Last Name:JELLO
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:PO BOX 443
Mailing Address - Street 2:
Mailing Address - City:WEST OSSIPEE
Mailing Address - State:NH
Mailing Address - Zip Code:03890-0443
Mailing Address - Country:US
Mailing Address - Phone:603-452-4442
Mailing Address - Fax:
Practice Address - Street 1:19 PORTLAND RD
Practice Address - Street 2:
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009-1229
Practice Address - Country:US
Practice Address - Phone:207-647-5795
Practice Address - Fax:207-647-2086
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-13
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR4027183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist