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General NPI Number Information
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NPI Number | 1295336485
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Entity Type | Individual
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Provider Name | JENNIFER K LAGERBOM R.PH.
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Gender | Female
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Dates
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Enumeration Date | 11/04/2020
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Last Update Date | 11/04/2020
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Provider Practice Location Address
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Address Line | 93 LINCOLNVILLE AVE
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City | BELFAST
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State | ME
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Zip | 04915-6461
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Country | US
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Telephone | 207-338-1918
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Fax | 207-338-1276
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Provider Business Mailing Address
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Address Line | 93 LINCOLNVILLE AVE
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City | BELFAST
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State | ME
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Zip | 04915-6461
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Country | US
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Telephone | 207-338-1918
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Fax | 207-338-1276
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PR4650
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License Number State | ME
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