Basic Information
| Provider Information | |||||||||
| NPI: | 1083298442 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDERS | ||||||||
| FirstName: | MINDY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 60 CHURCH RD | ||||||||
| Address2: | |||||||||
| City: | BUCKSPORT | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044165002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074090436 | ||||||||
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| Practice Location | |||||||||
| Address1: | 489 STATE ST | ||||||||
| Address2: | PHARMACY DEPARTMENT | ||||||||
| City: | BANGOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079737000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2021 | ||||||||
| LastUpdateDate: | 05/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P0018X | PR45451 | ME | Y | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
No ID Information.