Provider Demographics
NPI:1821584525
Name:DESFOSSES, ERIN (PHARM D)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:DESFOSSES
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 TIBBETTS DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2680
Mailing Address - Country:US
Mailing Address - Phone:207-725-1176
Mailing Address - Fax:
Practice Address - Street 1:15 TIBBETTS DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2680
Practice Address - Country:US
Practice Address - Phone:207-725-1176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR6078183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist