Healthcare Provider Details

I. General information

NPI: 1275539397
Provider Name (Legal Business Name): JAMIE L/ CRONIN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

489 STATE ST
BANGOR ME
04401-6616
US

IV. Provider business mailing address

125 YANKEE AVE
BANGOR ME
04401-2761
US

V. Phone/Fax

Practice location:
  • Phone: 207-973-8756
  • Fax:
Mailing address:
  • Phone: 207-945-6439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPR4024
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: