MEDICARE: MR. MICHAEL FREDERICK BRECKINRIDGE RPH

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	PR5079	ME

General Provider Information

NPI Number	:	1457455842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL FREDERICK BRECKINRIDGE RPH

Provider Business Mailing Address
First Line	:	32 HARRISON ST
Second Line	:
City	:	CALAIS
State	:	ME
Zip	:	04619-1106
Country	:	US
Telephone Number	:	207-853-0644
Fax Number	:	207-853-6230

Provider Business Practice Location Address
First Line	:	RT. 190, BACK RD.
Second Line	:
City	:	PERRY
State	:	ME
Zip	:	04667-0001
Country	:	US
Telephone Number	:	207-853-0644
Fax Number	:	207-853-6230

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

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	07/08/2007

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Directions to “ MR. MICHAEL FREDERICK BRECKINRIDGE RPH” Practice Location

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