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General NPI Number Information
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NPI Number | 1629667076
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Entity Type | Individual
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Provider Name | MICHELE LEBLANC
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Gender | Female
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Dates
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Enumeration Date | 01/11/2021
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Last Update Date | 01/11/2021
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Provider Practice Location Address
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Address Line | 2 OLD POINT AVE
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City | MADISON
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State | ME
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Zip | 04950-1115
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Country | US
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Telephone | 207-696-3935
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 57
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City | MADISON
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State | ME
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Zip | 04950-0057
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Country | US
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Telephone | 207-446-1396
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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 | PR4466
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License Number State | ME
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