Provider Demographics
NPI:1245582691
Name:DUBOIS, ERICA K (PHARM D)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:K
Last Name:DUBOIS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-7241
Mailing Address - Country:US
Mailing Address - Phone:207-626-0364
Mailing Address - Fax:207-626-0470
Practice Address - Street 1:600 CENTER ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-6311
Practice Address - Country:US
Practice Address - Phone:207-783-8951
Practice Address - Fax:207-514-2070
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR6030183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist