Active NPI
Chrysalis Wild
- Pharmacist
- Bangor, ME
National Provider Identifier
1407231558
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PR12432
- Practice address
- 60 Longview Dr
Bangor, ME 04401-3629 - Phone
- (207) 945-9977
- NPI assigned
- Jul 29, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PR12432 | ME | Primary |
Addresses
Primary practice location
60 Longview Dr
Bangor, ME 04401-3629
Mailing address
60 Longview Dr
Bangor, ME 04401-3629
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PR12432 | ME | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1438128000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1438128000000",
"number": "1407231558",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "60 LONGVIEW DR",
"city": "BANGOR",
"state": "ME",
"postal_code": "044013629"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "60 LONGVIEW DR",
"city": "BANGOR",
"state": "ME",
"postal_code": "044013629",
"telephone_number": "207-945-9977"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILD",
"first_name": "CHRYSALIS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-07-29",
"last_updated": "2015-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ME",
"license": "PR12432",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bangor, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.