Provider Demographics
NPI:1750982948
Name:CUSHING, SAMUEL GRANT (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:GRANT
Last Name:CUSHING
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 1:93 LINCOLNVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-6461
Mailing Address - Country:US
Mailing Address - Phone:207-338-1918
Mailing Address - Fax:
Practice Address - Street 1:93 LINCOLNVILLE AVE
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6461
Practice Address - Country:US
Practice Address - Phone:207-338-1918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR68751183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist