Provider Demographics
NPI:1891000949
Name:NADEAU, DEREK M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:M
Last Name:NADEAU
Suffix:
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 1:32 STONEWALL RD
Mailing Address - Street 2:
Mailing Address - City:WALES
Mailing Address - State:ME
Mailing Address - Zip Code:04280
Mailing Address - Country:US
Mailing Address - Phone:207-240-2333
Mailing Address - Fax:
Practice Address - Street 1:32 STONEWALL RD
Practice Address - Street 2:
Practice Address - City:WALES
Practice Address - State:ME
Practice Address - Zip Code:04280-4147
Practice Address - Country:US
Practice Address - Phone:207-240-2333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR5300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist