Provider Demographics
NPI:1760432561
Name:POWIS, RICHARD RUSSELL (RPH)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:RUSSELL
Last Name:POWIS
Suffix:
Gender:M
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:PO BOX 466
Mailing Address - Street 2:33 WHIPPOORWILL DRIVE
Mailing Address - City:BOOTHBAY
Mailing Address - State:ME
Mailing Address - Zip Code:04537-0466
Mailing Address - Country:US
Mailing Address - Phone:207-633-7959
Mailing Address - Fax:
Practice Address - Street 1:223 TOWNSEND AVE
Practice Address - Street 2:
Practice Address - City:BOOTHBAY HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04538-1847
Practice Address - Country:US
Practice Address - Phone:207-633-7023
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR4730183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist