Provider Demographics
NPI:1659652402
Name:PINETTE, PINETTE VAUGHN
Entity Type:Individual
Prefix:MR
First Name:PINETTE
Middle Name:VAUGHN
Last Name:PINETTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 BECKSTROM RD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04736-5762
Mailing Address - Country:US
Mailing Address - Phone:207-492-0071
Mailing Address - Fax:
Practice Address - Street 1:355 MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT FAIRFIELD
Practice Address - State:ME
Practice Address - Zip Code:04742-1143
Practice Address - Country:US
Practice Address - Phone:207-472-1191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR2895183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist