Provider Demographics
NPI:1831667278
Name:LEVESQUE, ANNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:LEVESQUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 US-1
Mailing Address - Street 2:STE 1
Mailing Address - City:BUCKSPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04416
Mailing Address - Country:US
Mailing Address - Phone:207-469-2201
Mailing Address - Fax:207-469-6803
Practice Address - Street 1:220 US-1
Practice Address - Street 2:STE 1
Practice Address - City:BUCKSPORT
Practice Address - State:ME
Practice Address - Zip Code:04416
Practice Address - Country:US
Practice Address - Phone:207-469-2201
Practice Address - Fax:207-469-6803
Is Sole Proprietor?:No
Enumeration Date:2018-11-04
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR68941183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist