Provider Demographics
NPI:1780275073
Name:LECLAIR, JENNEE
Entity type:Individual
Prefix:
First Name:JENNEE
Middle Name:
Last Name:LECLAIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNEE
Other - Middle Name:
Other - Last Name:FENNO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:148 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:MA
Mailing Address - Zip Code:01033-9551
Mailing Address - Country:US
Mailing Address - Phone:413-885-8201
Mailing Address - Fax:
Practice Address - Street 1:759 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01199-0001
Practice Address - Country:US
Practice Address - Phone:413-794-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPT7881183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician