Healthcare Provider Details

I. General information

NPI: 1710389200
Provider Name (Legal Business Name): IRENE MADRIGAL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 07/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 UNION ST
BANGOR ME
04401-3060
US

IV. Provider business mailing address

PO BOX 1599
BANGOR ME
04402-1599
US

V. Phone/Fax

Practice location:
  • Phone: 207-404-8100
  • Fax:
Mailing address:
  • Phone: 207-945-5247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPR5514
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: