Provider Demographics
NPI:1033669510
Name:DEPUE, JOHN PHILIP (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PHILIP
Last Name:DEPUE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 FARM BROOK RD
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:ME
Mailing Address - Zip Code:04330-2506
Mailing Address - Country:US
Mailing Address - Phone:207-649-4164
Mailing Address - Fax:
Practice Address - Street 1:172 FARM BROOK RD
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:ME
Practice Address - Zip Code:04330-2506
Practice Address - Country:US
Practice Address - Phone:207-649-4164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR46180183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist