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General NPI Number Information
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NPI Number | 1295076800
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Entity Type | Individual
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Provider Name | ALEJANDRO A. ENRIQUEZ ZAMALLOA PHARMD, MS
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Gender | Male
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Dates
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Enumeration Date | 03/06/2013
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Last Update Date | 05/07/2015
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Provider Practice Location Address
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Address Line | 14 MAINE ST SUITE 208
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City | BRUNSWICK
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State | ME
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Zip | 04011-2049
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Country | US
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Telephone | 207-907-1612
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Fax |
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Provider Business Mailing Address
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Address Line | 601 ALLEN AVE
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City | PORTLAND
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State | ME
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Zip | 04103-6101
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Country | US
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Telephone | 207-907-9722
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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 | PR12573
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH233995
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License Number State | MA
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