Individual
MR. OWEN THERIAULT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD.
Contact information
Practice address
987 LISBON ST, LEWISTON, ME 04240
(207) 784-9588
Mailing address
987 LISBON ST, LEWISTON, ME 04240-5747
(207) 784-9588
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
PR5627
ME
183500000X
Pharmacist
Primary
PS48724
FL
Other
Enumeration date
08/31/2011
Last updated
06/05/2019
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