Healthcare Provider Details

I. General information

NPI: 1588600514
Provider Name (Legal Business Name): NAPLES PROFESSIONAL PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 MESERVE ST
NAPLES ME
04055-5346
US

IV. Provider business mailing address

PO BOX 1620
NAPLES ME
04055-1620
US

V. Phone/Fax

Practice location:
  • Phone: 207-693-6111
  • Fax: 207-693-4942
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH50001196
License Number StateME

VIII. Authorized Official

Name: KIM FICKER
Title or Position: OWNER
Credential: RPH
Phone: 207-693-6111