Healthcare Provider Details

I. General information

NPI: 1598585002
Provider Name (Legal Business Name): JEREMY VUONG PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 07/04/2025
Certification Date: 07/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 COUNTY RD
WESTBROOK ME
04092-1901
US

IV. Provider business mailing address

16 BEAVER WOODS DR
DURHAM ME
04222-5491
US

V. Phone/Fax

Practice location:
  • Phone: 207-662-1800
  • Fax: 207-661-7838
Mailing address:
  • Phone: 207-841-6886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPR72023
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: