Provider Demographics
NPI:1154621696
Name:OUELLETTE, CHARLES J (RPH)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:J
Last Name:OUELLETTE
Suffix:
Gender:M
Credentials:RPH
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Mailing Address - Street 1:182 MARKET ST
Mailing Address - Street 2:SUITE 2 PO BOX 189
Mailing Address - City:FORT KENT
Mailing Address - State:ME
Mailing Address - Zip Code:04743-1514
Mailing Address - Country:US
Mailing Address - Phone:207-834-2880
Mailing Address - Fax:207-834-2882
Practice Address - Street 1:182 MARKET ST
Practice Address - Street 2:SUITE 2
Practice Address - City:FORT KENT
Practice Address - State:ME
Practice Address - Zip Code:04743-1514
Practice Address - Country:US
Practice Address - Phone:207-834-2880
Practice Address - Fax:207-834-2882
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEPR4202183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist