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General NPI Number Information
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NPI Number | 1790404671
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Entity Type | Individual
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Provider Name | CASSIDY PATRICIA COYNE PHARM D
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Gender | Female
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Dates
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Enumeration Date | 08/24/2022
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Last Update Date | 08/24/2022
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Provider Practice Location Address
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Address Line | 111 AUBURN ST
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City | PORTLAND
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State | ME
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Zip | 04103-2103
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Country | US
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Telephone | 207-797-3393
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Fax |
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Provider Business Mailing Address
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Address Line | 111 SAUGUS ST
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City | PORTLAND
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State | ME
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Zip | 04103-1465
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Country | US
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Telephone | 207-317-1444
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PR71150
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License Number State | ME
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