MEDICARE: DR. DAVINA RAE CELANI PHARMD

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	PR68692	ME

General Provider Information

NPI Number	:	1790389641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVINA RAE CELANI PHARMD

Provider Business Mailing Address
First Line	:	770 ROOSEVELT TRL
Second Line	:
City	:	WINDHAM
State	:	ME
Zip	:	04062-5300
Country	:	US
Telephone Number	:	207-892-2541
Fax Number	:

Provider Business Practice Location Address
First Line	:	770 ROOSEVELT TRL
Second Line	:
City	:	WINDHAM
State	:	ME
Zip	:	04062-5300
Country	:	US
Telephone Number	:	207-892-2541
Fax Number	:	207-892-9296

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

Provider Enumeration Date	:	11/22/2020
Last Update Date	:	11/22/2020

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