Provider Demographics
NPI:1437365061
Name:INGALLS, DAVID GILMORE (RPH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:GILMORE
Last Name:INGALLS
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 1:4 NEWCASTLE LN
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04429
Mailing Address - Country:US
Mailing Address - Phone:207-947-8369
Mailing Address - Fax:207-947-0894
Practice Address - Street 1:40 NEWCASTLE LN
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:ME
Practice Address - Zip Code:04429
Practice Address - Country:US
Practice Address - Phone:207-947-8369
Practice Address - Fax:207-947-0894
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR4649183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist