Healthcare Provider Details

I. General information

NPI: 1760501050
Provider Name (Legal Business Name): COLLEEN R. HUFF RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 MEDICAL CENTER DR SUITE G-500
BRUNSWICK ME
04011-2653
US

IV. Provider business mailing address

121 MEDICAL CENTER DR SUITE G-500
BRUNSWICK ME
04011-2653
US

V. Phone/Fax

Practice location:
  • Phone: 207-729-3642
  • Fax: 207-729-2704
Mailing address:
  • Phone: 207-729-3642
  • Fax: 207-729-2704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPR4244
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: