Provider Demographics
NPI:1790404671
Name:COYNE, CASSIDY PATRICIA (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:CASSIDY
Middle Name:PATRICIA
Last Name:COYNE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 SAUGUS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-1465
Mailing Address - Country:US
Mailing Address - Phone:207-317-1444
Mailing Address - Fax:
Practice Address - Street 1:111 AUBURN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2103
Practice Address - Country:US
Practice Address - Phone:207-797-3393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR711503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy