Healthcare Provider Details

I. General information

NPI: 1982128500
Provider Name (Legal Business Name): BRENTEN LAFFELY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 ELM ST
BRUNSWICK ME
04011-2422
US

IV. Provider business mailing address

1 CAMILLE DR
LISBON ME
04250-6028
US

V. Phone/Fax

Practice location:
  • Phone: 207-729-1604
  • Fax:
Mailing address:
  • Phone: 207-751-0239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPR69395
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: