MEDICARE: EMILY DEE RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PR69907	ME

General Provider Information

NPI Number	:	1124634613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY DEE RPH

Provider Business Mailing Address
First Line	:	335 FOREST AVE APT 206
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04101-2020
Country	:	US
Telephone Number	:	207-538-7816
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 MAPLE ST
Second Line	:
City	:	CORNISH
State	:	ME
Zip	:	04020-3141
Country	:	US
Telephone Number	:	207-625-8050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2020
Last Update Date	:	09/20/2020

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Directions to “ EMILY DEE RPH” Practice Location

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