Provider Demographics
NPI:1518197920
Name:PELLETIER, SHAWN D (PHARM D)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:D
Last Name:PELLETIER
Suffix:
Gender:M
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 1:429 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MADAWASKA
Mailing Address - State:ME
Mailing Address - Zip Code:04756-1082
Mailing Address - Country:US
Mailing Address - Phone:207-728-3815
Mailing Address - Fax:207-728-6350
Practice Address - Street 1:429 MAIN ST
Practice Address - Street 2:
Practice Address - City:MADAWASKA
Practice Address - State:ME
Practice Address - Zip Code:04756-1082
Practice Address - Country:US
Practice Address - Phone:207-728-3815
Practice Address - Fax:207-728-6350
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR5611183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist