Ethan Clarence Gagnon

Primary specialty

Pharmacy TechnicianTaxonomy code 183700000X

License

PI71263 Issued in ME

Practice address

125 Topsham Fair Mall Rd
Topsham, ME 04086-1741

Phone

(207) 504-5051

Fax

(207) 504-5396

NPI assigned

Aug 14, 2023

Last updated

Aug 14, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1691971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691971200000",
    "number": "1942983184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 OAK GROVE AVE APT 25",
            "city": "BATH",
            "state": "ME",
            "postal_code": "045302372",
            "telephone_number": "207-380-7153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 TOPSHAM FAIR MALL RD",
            "city": "TOPSHAM",
            "state": "ME",
            "postal_code": "040861741",
            "telephone_number": "207-504-5051",
            "fax_number": "207-504-5396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAGNON",
        "first_name": "ETHAN",
        "middle_name": "CLARENCE",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-08-14",
        "last_updated": "2023-08-14",
        "certification_date": "2023-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183700000X",
            "taxonomy_group": "",
            "desc": "Pharmacy Technician",
            "state": "ME",
            "license": "PI71263",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pharmacy Technician in Topsham, ME
• Providers in Topsham, ME by specialty
• Pharmacy Technician in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.