Provider Demographics
NPI:1982940102
Name:WAKELAND, PAULA LESLIE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:LESLIE
Last Name:WAKELAND
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:PAULA
Other - Middle Name:L
Other - Last Name:WAKELAND-HEWITT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:5426 SHADOW LAWN DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34242-1833
Mailing Address - Country:US
Mailing Address - Phone:941-346-0797
Mailing Address - Fax:
Practice Address - Street 1:5124 OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34242-1637
Practice Address - Country:US
Practice Address - Phone:941-349-1111
Practice Address - Fax:941-312-0631
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-15
Last Update Date:2012-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS30617183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS30617OtherPHARMACY LICENSE