Provider Demographics
NPI:1831489145
Name:COURCHAINE, ROY ALBERT JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:ALBERT
Last Name:COURCHAINE
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01510
Mailing Address - Country:US
Mailing Address - Phone:508-612-4762
Mailing Address - Fax:
Practice Address - Street 1:1031 MAIN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MA
Practice Address - Zip Code:01510-1134
Practice Address - Country:US
Practice Address - Phone:978-368-8540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH232500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPH232500OtherPHARMACY LICENSE