Provider Demographics
NPI:1043596141
Name:REMILLARD, ROBERT ALLEN (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ALLEN
Last Name:REMILLARD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 KENNEDY MEMORIAL DR
Mailing Address - Street 2:SHAWS SUPERMARKET
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4558
Mailing Address - Country:US
Mailing Address - Phone:207-680-3001
Mailing Address - Fax:207-680-3011
Practice Address - Street 1:251 KENNEDY MEMORIAL DR
Practice Address - Street 2:SHAWS SUPERMARKET
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4558
Practice Address - Country:US
Practice Address - Phone:207-680-3001
Practice Address - Fax:207-680-3011
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR3884183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist