Individual
AMY LYNNE VAILLANCOURT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD.
Contact information
Practice address
194 E MAIN ST, FORT KENT, ME 04743-1428
(207) 834-1690
(207) 834-1691
Mailing address
PO BOX 221, FORT KENT, ME 04743-0221
(207) 449-9060
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PR46755
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PR46755
MAINE BOARD OF PHARMACY
ME
Enumeration date
08/14/2017
Last updated
10/01/2019
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