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NPI Code Detail

MEDICARE: DR. MYCHAL ELIZABETH WARD-PISTONE PHARMD

MEDICARE: DR. MYCHAL ELIZABETH WARD-PISTONE PHARMD
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
1183500000XPharmacistPR6059ME

General Provider Information

NPI Number : 1255615472
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MYCHAL ELIZABETH WARD-PISTONE PHARMD
Provider Business Mailing Address
First Line : 14 BLACK BIRD WAY
Second Line :
City : FAYETTE
State : ME
Zip : 04349-3223
Country : US
Telephone Number : 207-333-9200
Fax Number :
Provider Business Practice Location Address
First Line : 317 MAIN ST
Second Line :
City : FARMINGTON
State : ME
Zip : 04938-5803
Country : US
Telephone Number : 207-778-3919
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2011
Last Update Date : 10/06/2011

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