Provider Demographics
NPI:1073117024
Name:LEVESQUE, EILEEN RITA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:RITA
Last Name:LEVESQUE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 HOPES WAY
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04021-4122
Mailing Address - Country:US
Mailing Address - Phone:401-741-6312
Mailing Address - Fax:
Practice Address - Street 1:141 PREBLE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2440
Practice Address - Country:US
Practice Address - Phone:207-253-3525
Practice Address - Fax:207-899-0968
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR5217183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEPR5217OtherBOARD OF PHARMACY