Healthcare Provider Details

I. General information

NPI: 1609868603
Provider Name (Legal Business Name): MRS. DENYELL BETH GERCHMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 11/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 HOSPITAL DR
BRIDGTON ME
04009-1148
US

IV. Provider business mailing address

PO BOX 80 373 ROCKY KNOLL ROAD
DENMARK ME
04022-0080
US

V. Phone/Fax

Practice location:
  • Phone: 207-647-6142
  • Fax: 207-647-6242
Mailing address:
  • Phone: 207-452-2056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPR4899
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: