Individual
BRADLEY BOUCHARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
302 MAIN ST, OLD TOWN, ME 04468-1535
(207) 827-8021
Mailing address
41 COLONY PL, MILLINOCKET, ME 04462-1901
(207) 731-3810
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PR27869
ME
Other
Enumeration date
07/31/2014
Last updated
07/31/2014
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