Basic Information
| Provider Information | |||||||||
| NPI: | 1417295361 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOUCETTE | ||||||||
| FirstName: | DEIRDRE | ||||||||
| MiddleName: | JAYNE RHEAUME | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DOUCETTE | ||||||||
| OtherFirstName: | DEEDEE | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | RPH | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 107 COMMERCIAL ST | ||||||||
| Address2: | |||||||||
| City: | MASHPEE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 026496507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084770004 | ||||||||
| FaxNumber: | 5084777028 | ||||||||
| Practice Location | |||||||||
| Address1: | 107 COMMERCIAL ST | ||||||||
| Address2: | |||||||||
| City: | MASHPEE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 026496507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084770004 | ||||||||
| FaxNumber: | 5084777028 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2013 | ||||||||
| LastUpdateDate: | 01/28/2013 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 22327 | MA | Y | Pharmacy Service Providers | Pharmacist | 183500000X | 03685 | RI | N | Pharmacy Service Providers | Pharmacist |
No ID Information.