=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447317821
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PATTEN DRUG LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2007
-----------------------------------------------------
Last Update Date | 11/15/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 MAIN ST
-----------------------------------------------------
City | PATTEN
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04765-3151
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-528-2244
-----------------------------------------------------
Fax | 207-528-2243
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 675
-----------------------------------------------------
City | PATTEN
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04765-0675
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRES
-----------------------------------------------------
Name | JOEL FITZPATRICK
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 207-528-2244
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PH50000115
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------