Provider Demographics
NPI:1184900292
Name:ANDERSON, DOUGLAS M
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-2022
Mailing Address - Country:US
Mailing Address - Phone:207-283-1353
Mailing Address - Fax:
Practice Address - Street 1:13 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-2022
Practice Address - Country:US
Practice Address - Phone:207-283-1353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR3874183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist