Provider Demographics
NPI:1811661473
Name:DIMARIO, ALEXIS CLAIR (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:CLAIR
Last Name:DIMARIO
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 CASCO ST APT 113
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2930
Mailing Address - Country:US
Mailing Address - Phone:740-260-6324
Mailing Address - Fax:
Practice Address - Street 1:99 MAIN ST
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1380
Practice Address - Country:US
Practice Address - Phone:207-839-6551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR70491183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist