Provider Demographics
NPI:1053459404
Name:PATTEN DRUG LLC
Entity type:Organization
Organization Name:PATTEN DRUG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-528-2244
Mailing Address - Street 1:PO BOX 675
Mailing Address - Street 2:
Mailing Address - City:PATTEN
Mailing Address - State:ME
Mailing Address - Zip Code:04765-0675
Mailing Address - Country:US
Mailing Address - Phone:207-528-2244
Mailing Address - Fax:207-528-2243
Practice Address - Street 1:20 MAIN ST
Practice Address - Street 2:
Practice Address - City:PATTEN
Practice Address - State:ME
Practice Address - Zip Code:04765-0000
Practice Address - Country:US
Practice Address - Phone:207-528-2244
Practice Address - Fax:207-528-2243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
MEPH500001153336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME010507344Medicaid
2002020OtherNCPDP PROVIDER IDENTIFICATION NUMBER
5912050001Medicare NSC