Provider Demographics
NPI:1801028428
Name:CHAREST, JEFFREY F (RPH)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:F
Last Name:CHAREST
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 1:246 FERRY RD
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-1103
Mailing Address - Country:US
Mailing Address - Phone:207-353-4843
Mailing Address - Fax:
Practice Address - Street 1:575 LISBON ST
Practice Address - Street 2:
Practice Address - City:LISBON FALLS
Practice Address - State:ME
Practice Address - Zip Code:04252-1114
Practice Address - Country:US
Practice Address - Phone:207-353-4843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-15
Last Update Date:2009-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR4103183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist