Provider Demographics
NPI:1972998599
Name:402 FRONT ST. LLC
Entity type:Organization
Organization Name:402 FRONT ST. LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LACTATION CONSULTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHOPFER
Authorized Official - Suffix:
Authorized Official - Credentials:BS, IBCLC, RLC
Authorized Official - Phone:302-304-3800
Mailing Address - Street 1:402 E FRONT ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-3956
Mailing Address - Country:US
Mailing Address - Phone:281-797-7222
Mailing Address - Fax:
Practice Address - Street 1:110 E PEMBREY DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-2004
Practice Address - Country:US
Practice Address - Phone:281-797-7222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-31
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-26371174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty