Provider Demographics
NPI:1295068963
Name:REA, ANTHONY JOHN (RPH, MA)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:JOHN
Last Name:REA
Suffix:
Gender:M
Credentials:RPH, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 GROVER BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:ME
Mailing Address - Zip Code:04224-3226
Mailing Address - Country:US
Mailing Address - Phone:207-357-3876
Mailing Address - Fax:
Practice Address - Street 1:7 PORTLAND ST
Practice Address - Street 2:
Practice Address - City:RUMFORD
Practice Address - State:ME
Practice Address - Zip Code:04276-2050
Practice Address - Country:US
Practice Address - Phone:207-364-2969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR5082183500000X
RIRPH03173183500000X
MAPH20121183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist