Provider Demographics
NPI:1205223476
Name:RORER, AMY DAVIS (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:DAVIS
Last Name:RORER
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 BRAMHALL ST
Mailing Address - Street 2:COMMUNITY PHARMACY
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3134
Mailing Address - Country:US
Mailing Address - Phone:207-662-2939
Mailing Address - Fax:207-662-6660
Practice Address - Street 1:22 BRAMHALL ST
Practice Address - Street 2:COMMUNITY PHARMACY
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3134
Practice Address - Country:US
Practice Address - Phone:207-662-2939
Practice Address - Fax:207-662-6660
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-24
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR5219183500000X
HIPH3196183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist