Provider Demographics
NPI:1003330234
Name:BOUCHARD, NOELLE (PHARMD, LMT)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:
Last Name:BOUCHARD
Suffix:
Gender:F
Credentials:PHARMD, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 PEACEFUL LN
Mailing Address - Street 2:
Mailing Address - City:NEW CANADA
Mailing Address - State:ME
Mailing Address - Zip Code:04743-3055
Mailing Address - Country:US
Mailing Address - Phone:207-316-2545
Mailing Address - Fax:
Practice Address - Street 1:104 MAIN ST
Practice Address - Street 2:
Practice Address - City:MADAWASKA
Practice Address - State:ME
Practice Address - Zip Code:04756-1437
Practice Address - Country:US
Practice Address - Phone:207-728-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR5202183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist