MEDICARE: KELLIE DAIGLE RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PR4863	ME

General Provider Information

NPI Number	:	1033712807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLIE DAIGLE RPH

Provider Business Mailing Address
First Line	:	PO BOX 515
Second Line	:
City	:	LINCOLN
State	:	ME
Zip	:	04457-0515
Country	:	US
Telephone Number	:	207-356-2011
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 GODING AVE
Second Line	:
City	:	LINCOLN
State	:	ME
Zip	:	04457-1323
Country	:	US
Telephone Number	:	207-356-2011
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2020
Last Update Date	:	11/16/2020

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