Provider Demographics
NPI:1558857953
Name:LEISENTRITT, DARLENE MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:MARIE
Last Name:LEISENTRITT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 WORCESTER WAY
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:ME
Mailing Address - Zip Code:04457-4427
Mailing Address - Country:US
Mailing Address - Phone:207-403-3629
Mailing Address - Fax:207-794-0220
Practice Address - Street 1:250 W BROADWAY
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:ME
Practice Address - Zip Code:04457-4006
Practice Address - Country:US
Practice Address - Phone:207-794-2055
Practice Address - Fax:207-794-0220
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME4084183500000X
MEPR4084183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist