MEDICARE: MRS. CHRISTIE SKINNER FREEMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PR6475	ME

General Provider Information

NPI Number	:	1003164583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTIE SKINNER FREEMAN

Provider Business Mailing Address
First Line	:	84 E MAIN ST
Second Line	:
City	:	FORT KENT
State	:	ME
Zip	:	04743-1322
Country	:	US
Telephone Number	:	207-834-5444
Fax Number	:

Provider Business Practice Location Address
First Line	:	84 E MAIN ST
Second Line	:
City	:	FORT KENT
State	:	ME
Zip	:	04743-1322
Country	:	US
Telephone Number	:	207-834-5444
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2012
Last Update Date	:	08/15/2012

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