MEDICARE: TIMOTHY JAMES AHEARN

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	PR4018	ME

General Provider Information

NPI Number	:	1760883425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY JAMES AHEARN

Provider Business Mailing Address
First Line	:	20 GARLAND RD
Second Line	:
City	:	WINSLOW
State	:	ME
Zip	:	04901-0600
Country	:	US
Telephone Number	:	207-872-7979
Fax Number	:	207-872-7922

Provider Business Practice Location Address
First Line	:	20 GARLAND RD
Second Line	:
City	:	WINSLOW
State	:	ME
Zip	:	04901-0600
Country	:	US
Telephone Number	:	207-872-7979
Fax Number	:	207-872-7922

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

Provider Enumeration Date	:	09/11/2014
Last Update Date	:	09/11/2014

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