Healthcare Provider Details

I. General information

NPI: 1104332691
Provider Name (Legal Business Name): KATRINA NIKORNPAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DR. KATRINA MORAN

II. Dates (important events)

Enumeration Date: 12/19/2017
Last Update Date: 12/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 SPRING ST
GARDINER ME
04345-1823
US

IV. Provider business mailing address

283 WATER ST STE 401
AUGUSTA ME
04330-4748
US

V. Phone/Fax

Practice location:
  • Phone: 207-582-3051
  • Fax:
Mailing address:
  • Phone: 207-592-1082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPR47048
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: