Healthcare Provider Details

I. General information

NPI: 1053459404
Provider Name (Legal Business Name): PATTEN DRUG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 03/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MAIN ST
PATTEN ME
04765-0000
US

IV. Provider business mailing address

PO BOX 675
PATTEN ME
04765-0675
US

V. Phone/Fax

Practice location:
  • Phone: 207-528-2244
  • Fax: 207-528-2243
Mailing address:
  • Phone: 207-528-2244
  • Fax: 207-528-2243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH50000115
License Number StateME

VIII. Authorized Official

Name: JOEL FITZPATRICK
Title or Position: OWNER
Credential:
Phone: 207-528-2244