Individual
PENNY PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
510 CONGRESS ST, PORTLAND, ME 04101-3416
(207) 774-4525
Mailing address
510 CONGRESS ST, PORTLAND, ME 04101-3416
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PR4825
ME
Other
Enumeration date
11/17/2020
Last updated
11/17/2020
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