Healthcare Provider Details

I. General information

NPI: 1972722338
Provider Name (Legal Business Name): JAMES THOMAS OLIVER RX
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 BRIDGTON RD
FRYEBURG ME
04037-1407
US

IV. Provider business mailing address

62 LOVEWELL POND RD
FRYEBURG ME
04037-1414
US

V. Phone/Fax

Practice location:
  • Phone: 207-935-4119
  • Fax:
Mailing address:
  • Phone: 207-935-2045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2898
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: