Provider Demographics
NPI:1083076939
Name:TREMBLAY, MICHAEL HENRY
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:HENRY
Last Name:TREMBLAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 136
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-0136
Mailing Address - Country:US
Mailing Address - Phone:207-490-3560
Mailing Address - Fax:
Practice Address - Street 1:1364 MAIN ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-3660
Practice Address - Country:US
Practice Address - Phone:207-490-3562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-21
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR3588183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist