Jonathan Niles, PHARM.D
Individual provider Active NPI Pharmacist · Winthrop, ME
NPI 1164023024 · NPPES record last updated Nov 5, 2020
Key facts
- NPI
- 1164023024
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- PR12894 (ME)
- Practice address
- 399 Main St
Winthrop, ME 04364-1531 - Phone
- (207) 377-3162
- NPI assigned
- Nov 5, 2020
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PR12894 | ME | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hannaford Bros. Co., LLC | Past |
Accepting new patients | |
| Hannaford Bros Co LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PR12894 | ME | Yes |
Addresses
Primary practice location
399 Main St
Winthrop, ME 04364-1531
Mailing address
399 Main St
Winthrop, ME 04364-1531
Phone (207) 377-3162
Other providers in Winthrop, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 5, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.