Healthcare Provider Details

I. General information

NPI: 1306076583
Provider Name (Legal Business Name): HARINI PAPPU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2009
Last Update Date: 07/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 UNION ST
BANGOR ME
04401-6160
US

IV. Provider business mailing address

226 UNION ST
BANGOR ME
04401-6160
US

V. Phone/Fax

Practice location:
  • Phone: 207-942-0515
  • Fax: 207-942-4856
Mailing address:
  • Phone: 207-942-0515
  • Fax: 207-942-4856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPR5335
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: