Provider Demographics
NPI:1114158219
Name:NARDOZZI, PETER MICHAEL (RPH, CIP)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:MICHAEL
Last Name:NARDOZZI
Suffix:
Gender:M
Credentials:RPH, CIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BRICKYARD CT
Mailing Address - Street 2:SIGNATURE PINES
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-1757
Mailing Address - Country:US
Mailing Address - Phone:207-607-4267
Mailing Address - Fax:
Practice Address - Street 1:10 BRICKYARD CT
Practice Address - Street 2:SIGNATURE PINES
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-1757
Practice Address - Country:US
Practice Address - Phone:207-607-4267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR4374183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEPR4374OtherDEPARTMENT OF PROFESSIONAL & FINANCIAL REGULATIONS/BOARD OF PHARMACY