Healthcare Provider Details

I. General information

NPI: 1508349382
Provider Name (Legal Business Name): ROGER EDMOND DUGUAY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

469 MAIN ST
JAY ME
04239-5062
US

IV. Provider business mailing address

469 MAIN ST
JAY ME
04239-5062
US

V. Phone/Fax

Practice location:
  • Phone: 207-320-9921
  • Fax:
Mailing address:
  • Phone: 207-320-9921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPR68588
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: