Individual
DR. PETER KOMBAKIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD PHARMACY
Contact information
Practice address
137 RAY ST, PORTLAND, ME 04103-4320
(207) 776-8452
Mailing address
137 RAY ST, PORTLAND, ME 04103-4320
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
4248
NH
183500000X
Pharmacist
Primary
PR46181
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4248
NH STATE PHARMACY LICENSE
NH
01
—
PR46181
MAINE STATE PHARMACY LICENSE
ME
Enumeration date
08/23/2018
Last updated
08/23/2018
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