Provider Demographics
NPI:1285943811
Name:DEOCAMPO, ANJE THOMAS (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:ANJE
Middle Name:THOMAS
Last Name:DEOCAMPO
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 NE JENSEN BEACH BLVD.
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957
Mailing Address - Country:US
Mailing Address - Phone:772-463-5316
Mailing Address - Fax:772-463-5319
Practice Address - Street 1:1114 NE JENSEN BEACH BLVD.
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957
Practice Address - Country:US
Practice Address - Phone:772-463-5316
Practice Address - Fax:772-463-5319
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS46624183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist