Healthcare Provider Details

I. General information

NPI: 1457455842
Provider Name (Legal Business Name): MICHAEL FREDERICK BRECKINRIDGE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RT. 190, BACK RD.
PERRY ME
04667-0001
US

IV. Provider business mailing address

32 HARRISON ST
CALAIS ME
04619-1106
US

V. Phone/Fax

Practice location:
  • Phone: 207-853-0644
  • Fax: 207-853-6230
Mailing address:
  • Phone: 207-853-0644
  • Fax: 207-853-6230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPR5079
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: