Provider Demographics
NPI:1992086953
Name:DOORENBOS, CAROL ANN (RPH)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ANN
Last Name:DOORENBOS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE FALLS
Mailing Address - State:ME
Mailing Address - Zip Code:04254-1510
Mailing Address - Country:US
Mailing Address - Phone:207-897-6781
Mailing Address - Fax:207-897-9574
Practice Address - Street 1:81 MAIN ST
Practice Address - Street 2:
Practice Address - City:LIVERMORE FALLS
Practice Address - State:ME
Practice Address - Zip Code:04254-1510
Practice Address - Country:US
Practice Address - Phone:207-897-6781
Practice Address - Fax:207-897-9574
Is Sole Proprietor?:No
Enumeration Date:2011-09-05
Last Update Date:2011-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR4637183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist