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General NPI Number Information
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NPI Number | 1467828376
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Entity Type | Individual
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Provider Name | KELLY CARUSO
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Gender | Female
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Dates
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Enumeration Date | 08/14/2015
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Last Update Date | 08/14/2015
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Provider Practice Location Address
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Address Line | 465 MAIN ST
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City | WESTBROOK
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State | ME
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Zip | 04092-4328
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Country | US
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Telephone | 570-421-1773
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Fax |
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Provider Business Mailing Address
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Address Line | 286 FRONT ST APT 1
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-1558
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Country | US
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Telephone | 207-240-5015
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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 | PR45380
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License Number State | ME
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