Provider Demographics
NPI:1457455842
Name:BRECKINRIDGE, MICHAEL FREDERICK (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:FREDERICK
Last Name:BRECKINRIDGE
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 1:32 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:CALAIS
Mailing Address - State:ME
Mailing Address - Zip Code:04619-1106
Mailing Address - Country:US
Mailing Address - Phone:207-853-0644
Mailing Address - Fax:207-853-6230
Practice Address - Street 1:RT. 190, BACK RD.
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:ME
Practice Address - Zip Code:04667-0001
Practice Address - Country:US
Practice Address - Phone:207-853-0644
Practice Address - Fax:207-853-6230
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR5079183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist