Provider Demographics
NPI:1417295361
Name:DOUCETTE, DEIRDRE JAYNE RHEAUME
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:JAYNE RHEAUME
Last Name:DOUCETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEEDEE
Other - Middle Name:
Other - Last Name:DOUCETTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:107 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-6507
Mailing Address - Country:US
Mailing Address - Phone:508-477-0004
Mailing Address - Fax:508-477-7028
Practice Address - Street 1:107 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-6507
Practice Address - Country:US
Practice Address - Phone:508-477-0004
Practice Address - Fax:508-477-7028
Is Sole Proprietor?:No
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22327183500000X
RI03685183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist