Provider Demographics
NPI:1245726496
Name:NIELSEN, MARK ANDREW (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ANDREW
Last Name:NIELSEN
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 LANDING RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-5562
Mailing Address - Country:US
Mailing Address - Phone:207-893-0654
Mailing Address - Fax:207-893-0664
Practice Address - Street 1:30 LANDING RD
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-5560
Practice Address - Country:US
Practice Address - Phone:207-893-0654
Practice Address - Fax:207-893-0664
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-10
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR5651183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist