Provider Demographics
NPI:1952778896
Name:BOSSIE, COLLEEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:BOSSIE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-2217
Mailing Address - Country:US
Mailing Address - Phone:617-780-7953
Mailing Address - Fax:
Practice Address - Street 1:53 PARIS ST
Practice Address - Street 2:
Practice Address - City:NORWAY
Practice Address - State:ME
Practice Address - Zip Code:04268-5631
Practice Address - Country:US
Practice Address - Phone:617-780-7953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR45388183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist