Provider Demographics
NPI:1356356976
Name:RIDDLES PHARMACY INC
Entity type:Organization
Organization Name:RIDDLES PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES AND PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:JOEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLAFFERTY
Authorized Official - Suffix:
Authorized Official - Credentials:REG PH
Authorized Official - Phone:207-864-3441
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:RANGELEY
Mailing Address - State:ME
Mailing Address - Zip Code:04970-0010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2487 MAIN STREET
Practice Address - Street 2:
Practice Address - City:RANGELEY
Practice Address - State:ME
Practice Address - Zip Code:04970-0010
Practice Address - Country:US
Practice Address - Phone:207-864-3441
Practice Address - Fax:207-864-3916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPH500001783336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2002107OtherOTHER ID NUMBER
2002107OtherOTHER ID NUMBER-COMMERCIAL NUMBER
ME=========Medicaid
2002107OtherOTHER ID NUMBER-COMMERCIAL NUMBER