Provider Demographics
NPI:1174814396
Name:FELTY, MARION BRETT (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARION
Middle Name:BRETT
Last Name:FELTY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:ME
Mailing Address - Zip Code:04785-1008
Mailing Address - Country:US
Mailing Address - Phone:207-868-2626
Mailing Address - Fax:207-868-5496
Practice Address - Street 1:21 MAIN ST
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:ME
Practice Address - Zip Code:04785-1008
Practice Address - Country:US
Practice Address - Phone:207-868-2626
Practice Address - Fax:207-868-5496
Is Sole Proprietor?:No
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR4591183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist