Provider Demographics
NPI:1003491374
Name:BELL, JUDY L
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:L
Last Name:BELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 FAIRGROUNDS MKT PL
Mailing Address - Street 2:
Mailing Address - City:SKOWHEGAN
Mailing Address - State:ME
Mailing Address - Zip Code:04976-1367
Mailing Address - Country:US
Mailing Address - Phone:207-474-3013
Mailing Address - Fax:207-858-0489
Practice Address - Street 1:60 FAIRGROUNDS MKT PL
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976-1367
Practice Address - Country:US
Practice Address - Phone:207-474-3013
Practice Address - Fax:207-858-0489
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT60003106183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician