Provider Demographics
NPI:1760072300
Name:DUNNE, JANE MARTIN (RPH)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:MARTIN
Last Name:DUNNE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 DIBIASE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-1119
Mailing Address - Country:US
Mailing Address - Phone:207-415-7633
Mailing Address - Fax:
Practice Address - Street 1:52 DIBIASE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-1119
Practice Address - Country:US
Practice Address - Phone:207-415-7633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-18
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR4129183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist