Healthcare Provider Details

I. General information

NPI: 1881696359
Provider Name (Legal Business Name): LUCAS JASON BAYNE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2005
Last Update Date: 09/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 E SIDE TRL
OAKLAND ME
04963-4462
US

IV. Provider business mailing address

415 E SIDE TRL
OAKLAND ME
04963-4462
US

V. Phone/Fax

Practice location:
  • Phone: 207-465-7271
  • Fax:
Mailing address:
  • Phone: 207-465-7271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPR5089
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: