Healthcare Provider Details

I. General information

NPI: 1710396189
Provider Name (Legal Business Name): CHRISTOPHER IVES PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2014
Last Update Date: 08/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 TOWNSEND AVE
BOOTHBAY HARBOR ME
04538-1847
US

IV. Provider business mailing address

18 PINE HILL DR
BATH ME
04530-2073
US

V. Phone/Fax

Practice location:
  • Phone: 207-633-7023
  • Fax:
Mailing address:
  • Phone: 603-494-1505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPR27878
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: