Provider Demographics
NPI:1588982706
Name:LUCENTE STABILE, TATIANA
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:
Last Name:LUCENTE STABILE
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 1:2 AUTUMN WAY
Mailing Address - Street 2:
Mailing Address - City:SEABROOK
Mailing Address - State:NH
Mailing Address - Zip Code:03874-4249
Mailing Address - Country:US
Mailing Address - Phone:603-474-2341
Mailing Address - Fax:
Practice Address - Street 1:2 AUTUMN WAY
Practice Address - Street 2:
Practice Address - City:SEABROOK
Practice Address - State:NH
Practice Address - Zip Code:03874
Practice Address - Country:US
Practice Address - Phone:603-474-2342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHR2038183500000X
MA26643183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist