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General NPI Number Information
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NPI Number | 1013494962
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Entity Type | Individual
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Provider Name | MATTHEW DESJARDINS
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Gender | Male
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Dates
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Enumeration Date | 07/24/2018
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Last Update Date | 06/01/2021
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Provider Practice Location Address
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Address Line | 93 LINCOLNVILLE AVE
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City | BELFAST
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State | ME
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Zip | 04915-6461
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Country | US
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Telephone | 207-338-1918
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Fax |
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Provider Business Mailing Address
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Address Line | 125 TONER BOULEVARD
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City | NORTH ATTLEBORO
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State | MA
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Zip | 02760-6337
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Country | US
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Telephone | 508-643-0312
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH239640
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License Number State | MA
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