Provider Demographics
NPI:1154641967
Name:LENTOCHA, ANNA ANIELA
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:ANIELA
Last Name:LENTOCHA
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 1:48298 LAMPLIGHTER TRL
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-1434
Mailing Address - Country:US
Mailing Address - Phone:586-416-1689
Mailing Address - Fax:
Practice Address - Street 1:15250 24 MILE RD
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48042-5817
Practice Address - Country:US
Practice Address - Phone:586-677-1108
Practice Address - Fax:586-677-1129
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302028329183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist