Provider Demographics
NPI:1285417915
Name:CHASSE, AMBER KAITLYN
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:KAITLYN
Last Name:CHASSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 TREADWELL ACRES
Mailing Address - Street 2:
Mailing Address - City:HERMON
Mailing Address - State:ME
Mailing Address - Zip Code:04401-0756
Mailing Address - Country:US
Mailing Address - Phone:207-951-4652
Mailing Address - Fax:
Practice Address - Street 1:437 WILSON ST
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-1414
Practice Address - Country:US
Practice Address - Phone:207-991-9679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR71541183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist