Provider Demographics
NPI:1871710806
Name:BRESNAHAN, DAVID JOSEPH (RPH)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JOSEPH
Last Name:BRESNAHAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CARRIAGE WAY
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9602
Mailing Address - Country:US
Mailing Address - Phone:207-883-3719
Mailing Address - Fax:
Practice Address - Street 1:108A INDUSTRIAL WAY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-1082
Practice Address - Country:US
Practice Address - Phone:207-878-1288
Practice Address - Fax:207-878-0985
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR3978183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist