MEDICARE: PAUL MICHAEL CROOK 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
1	183500000X	Pharmacist	PR46398	ME

General Provider Information

NPI Number	:	1619329125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL MICHAEL CROOK PHARMD

Provider Business Mailing Address
First Line	:	91 AUBURN ST
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04103-6008
Country	:	US
Telephone Number	:	207-797-0536
Fax Number	:	207-797-2439

Provider Business Practice Location Address
First Line	:	91 AUBURN ST
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04103-6008
Country	:	US
Telephone Number	:	207-797-0536
Fax Number	:	207-797-2439

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

Provider Enumeration Date	:	07/08/2016
Last Update Date	:	03/05/2020

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