Provider Demographics
NPI:1194175430
Name:MAILLET, KEVIN (PHARMD)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:MAILLET
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 LAFAYETTE RD
Mailing Address - Street 2:
Mailing Address - City:SEABROOK
Mailing Address - State:NH
Mailing Address - Zip Code:03874-4213
Mailing Address - Country:US
Mailing Address - Phone:603-474-9511
Mailing Address - Fax:603-474-9604
Practice Address - Street 1:628 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:SEABROOK
Practice Address - State:NH
Practice Address - Zip Code:03874-4213
Practice Address - Country:US
Practice Address - Phone:603-474-9511
Practice Address - Fax:603-474-9604
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH235720183500000X
NH3948183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist