Healthcare Provider Details

I. General information

NPI: 1861772386
Provider Name (Legal Business Name): GRETCHEN RIKER GARDNER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2011
Last Update Date: 02/26/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 US-200
GREENE ME
04236
US

IV. Provider business mailing address

220 PARK ST
FARMINGDALE ME
04344-1518
US

V. Phone/Fax

Practice location:
  • Phone: 207-946-2425
  • Fax:
Mailing address:
  • Phone: 207-441-2850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH027779
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS 51686
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20732
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH 60228915
License Number StateWA
# 5
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPR70183
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: