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General NPI Number Information
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NPI Number | 1316601842
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Entity Type | Individual
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Provider Name | IAN A. MACOMBER
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Gender | Male
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Dates
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Enumeration Date | 10/31/2021
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Last Update Date | 10/31/2021
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Provider Practice Location Address
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Address Line | 112 BENNETT DR
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City | CARIBOU
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State | ME
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Zip | 04736-2022
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Country | US
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Telephone | 207-498-8735
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Fax |
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Provider Business Mailing Address
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Address Line | 115 WILLIAMS RD
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City | PRESQUE ISLE
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State | ME
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Zip | 04769-5266
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Country | US
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Telephone | 207-450-4682
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Fax |
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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 | PR69423
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License Number State | ME
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