Provider Demographics
NPI:1104412527
Name:DORE, JAIME (PHARMD)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:DORE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 REBECCA RD
Mailing Address - Street 2:
Mailing Address - City:DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02748-1167
Mailing Address - Country:US
Mailing Address - Phone:508-954-7174
Mailing Address - Fax:
Practice Address - Street 1:333 MARIANO BISHOP BLVD
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-2349
Practice Address - Country:US
Practice Address - Phone:508-675-0887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-20
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH26049183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
242706OtherNABP