Provider Demographics
NPI:1023619202
Name:CASTONGUAY, SCOTT THOMAS (PHARMACIST)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:THOMAS
Last Name:CASTONGUAY
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 DEERING RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:EAST WATERBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04030-5312
Mailing Address - Country:US
Mailing Address - Phone:207-459-0997
Mailing Address - Fax:
Practice Address - Street 1:20 SOKOKIS TRL
Practice Address - Street 2:
Practice Address - City:WATERBORO
Practice Address - State:ME
Practice Address - Zip Code:04087-3056
Practice Address - Country:US
Practice Address - Phone:207-247-3031
Practice Address - Fax:207-247-8724
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR4462183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist