Provider Demographics
NPI:1679886600
Name:CHARRON, JAMIE
Entity Type:Individual
Prefix:MR
First Name:JAMIE
Middle Name:
Last Name:CHARRON
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 1:6 DANIELS WAY
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1960
Mailing Address - Country:US
Mailing Address - Phone:207-653-8680
Mailing Address - Fax:
Practice Address - Street 1:478 ROUTE 1
Practice Address - Street 2:
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-6735
Practice Address - Country:US
Practice Address - Phone:207-846-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR4771183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist