Provider Demographics
NPI:1184225856
Name:HUSSEY, ERICA E
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:E
Last Name:HUSSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 EASTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-4201
Mailing Address - Country:US
Mailing Address - Phone:207-608-0775
Mailing Address - Fax:
Practice Address - Street 1:21 HANNAFORD DR
Practice Address - Street 2:
Practice Address - City:BUXTON
Practice Address - State:ME
Practice Address - Zip Code:04093-6583
Practice Address - Country:US
Practice Address - Phone:207-929-3152
Practice Address - Fax:207-929-3155
Is Sole Proprietor?:No
Enumeration Date:2020-11-08
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR12540183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist