Individual
DR. DUSTIN WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
47 HASKELL RD, BANGOR, ME 04401-4229
(207) 947-4606
Mailing address
79 HIGHPOINT PL, BRADLEY, ME 04411-5247
(603) 440-3016
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PR46271
ME
Other
Enumeration date
02/10/2021
Last updated
02/10/2021
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