MEDICARE: NAPLES PROFESSIONAL PHARMACY

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	PH50001196	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2007400	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1588600514
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NAPLES PROFESSIONAL PHARMACY

Provider Business Mailing Address
First Line	:	PO BOX 1620
Second Line	:
City	:	NAPLES
State	:	ME
Zip	:	04055-1620
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 MESERVE ST
Second Line	:
City	:	NAPLES
State	:	ME
Zip	:	04055-5346
Country	:	US
Telephone Number	:	207-693-6111
Fax Number	:	207-693-4942

Authorized Official
Title or Position	:	OWNER
Name	:	KIM FICKER
Credential	:	RPH
Telephone Number	:	207-693-6111

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	10/23/2007

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Directions to “NAPLES PROFESSIONAL PHARMACY ” Practice Location

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