Provider Demographics
NPI:1689450827
Name:GILVEY, JASON ALEXANDER
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:ALEXANDER
Last Name:GILVEY
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 1:22 BRAMHALL ST
Mailing Address - Street 2:ATTN: RETAIL PHARMACY
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102
Mailing Address - Country:US
Mailing Address - Phone:207-662-2626
Mailing Address - Fax:207-662-6660
Practice Address - Street 1:22 BRAMHALL ST
Practice Address - Street 2:ATTN: RETAIL PHARMACY
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102
Practice Address - Country:US
Practice Address - Phone:207-662-2626
Practice Address - Fax:207-662-6660
Is Sole Proprietor?:No
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR70715183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist