Provider Demographics
NPI:1841400215
Name:ROY, MARY A (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:A
Last Name:ROY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:A
Other - Last Name:GILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:10 LIBERTY LN
Mailing Address - Street 2:APT. 55
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-1977
Mailing Address - Country:US
Mailing Address - Phone:207-899-4408
Mailing Address - Fax:207-839-3257
Practice Address - Street 1:99 MAIN ST
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1303
Practice Address - Country:US
Practice Address - Phone:207-839-6551
Practice Address - Fax:207-839-3257
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR5342183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist