Provider Demographics
NPI:1528830387
Name:LAPORTE, JASON LUKE (PHARMD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:LUKE
Last Name:LAPORTE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 WATER ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-4667
Mailing Address - Country:US
Mailing Address - Phone:207-629-9401
Mailing Address - Fax:
Practice Address - Street 1:403 WATER ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-4667
Practice Address - Country:US
Practice Address - Phone:207-629-9401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR68762183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist