Provider Demographics
NPI:1730211574
Name:LEMAUX, JUDITH ANN (BSR,PH)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANN
Last Name:LEMAUX
Suffix:
Gender:F
Credentials:BSR,PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16084 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-2913
Mailing Address - Country:US
Mailing Address - Phone:586-775-5526
Mailing Address - Fax:
Practice Address - Street 1:20811 KELLY RD
Practice Address - Street 2:SUITE 103
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-3139
Practice Address - Country:US
Practice Address - Phone:586-498-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI208101835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI20810OtherPHARMACY LICENSE