Provider Demographics
NPI:1225409196
Name:FOURNIER, MARYESTHER (RPH)
Entity Type:Individual
Prefix:
First Name:MARYESTHER
Middle Name:
Last Name:FOURNIER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-5015
Mailing Address - Country:US
Mailing Address - Phone:781-245-0380
Mailing Address - Fax:781-245-1350
Practice Address - Street 1:390 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-5015
Practice Address - Country:US
Practice Address - Phone:781-245-0380
Practice Address - Fax:781-245-1350
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA163591835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care