Individual
KENT A ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
144 STATE ST, PORTLAND, ME 04101-3776
(207) 553-6787
Mailing address
96 TENPENNY ST, FREEPORT, ME 04032-6760
(720) 624-9730
Taxonomy
Speciality
Code
Description
License number
State
1835X0200X
Oncology Pharmacist
10751
OR
1835X0200X
Oncology Pharmacist
11900
ME
1835X0200X
Oncology Pharmacist
Primary
PR3788
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015812
KAISER-COMMERCIAL NUMBER
—
Enumeration date
03/07/2007
Last updated
01/26/2012
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