Provider Demographics
NPI:1376857458
Name:WYMAN, DAVID L (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:L
Last Name:WYMAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 AND 233 NORTH ST
Mailing Address - Street 2:RITE AID PHARMACY
Mailing Address - City:CALAIS
Mailing Address - State:ME
Mailing Address - Zip Code:04619
Mailing Address - Country:US
Mailing Address - Phone:207-454-2262
Mailing Address - Fax:
Practice Address - Street 1:223 AND 233 NORTH ST
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:CALAIS
Practice Address - State:ME
Practice Address - Zip Code:04619
Practice Address - Country:US
Practice Address - Phone:207-454-2262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR3691183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist