Healthcare Provider Details

I. General information

NPI: 1437027760
Provider Name (Legal Business Name): DR. JESSICA RICKETTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2025
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 PREBLE ST
PORTLAND ME
04101-2440
US

IV. Provider business mailing address

345 SACO ST UNIT 9
WESTBROOK ME
04092-2067
US

V. Phone/Fax

Practice location:
  • Phone: 207-899-0939
  • Fax:
Mailing address:
  • Phone: 508-818-8345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPR72670
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: