Individual
ETHAN GERVAIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
279 MAIN ST, SOUTH PORTLAND, ME 04106-2629
(207) 741-2260
Mailing address
61 LONGFELLOW ST, WESTBROOK, ME 04092-2631
(207) 415-6688
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PR70596
ME
Other
Enumeration date
09/14/2021
Last updated
09/14/2021
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