MEDICARE: RIDDLES PHARMACY INC

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	3336C0003X	Community/Retail Pharmacy	PH50000178	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2002107	OTHER		OTHER ID NUMBER
2	2002107	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1356356976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIDDLES PHARMACY INC

Provider Business Mailing Address
First Line	:	PO BOX 10
Second Line	:
City	:	RANGELEY
State	:	ME
Zip	:	04970-0010
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2487 MAIN STREET
Second Line	:
City	:	RANGELEY
State	:	ME
Zip	:	04970-0010
Country	:	US
Telephone Number	:	207-864-3441
Fax Number	:	207-864-3916

Authorized Official
Title or Position	:	PRES AND PHARMACIST IN CHARGE
Name	:	JOEY MCLAFFERTY
Credential	:	REG PH
Telephone Number	:	207-864-3441

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	04/20/2008

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Directions to “RIDDLES PHARMACY INC ” Practice Location

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