Provider Demographics
NPI:1275635138
Name:MATHIS, JAMES W (RPH, MS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:W
Last Name:MATHIS
Suffix:
Gender:M
Credentials:RPH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 AUGUSTA RD
Mailing Address - Street 2:
Mailing Address - City:BOWDOIN
Mailing Address - State:ME
Mailing Address - Zip Code:04287-7713
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:961 AUGUSTA RD
Practice Address - Street 2:
Practice Address - City:BOWDOIN
Practice Address - State:ME
Practice Address - Zip Code:04287-7713
Practice Address - Country:US
Practice Address - Phone:207-623-8411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR42481835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy