Provider Demographics
NPI:1750985768
Name:CHAMPEON, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:CHAMPEON
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:PO BOX 643
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:ME
Mailing Address - Zip Code:04457-0643
Mailing Address - Country:US
Mailing Address - Phone:207-794-6513
Mailing Address - Fax:207-794-6791
Practice Address - Street 1:22 GODING AVE
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:ME
Practice Address - Zip Code:04457-1323
Practice Address - Country:US
Practice Address - Phone:207-794-6513
Practice Address - Fax:207-794-6791
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR3840183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist