Mary Jo King, PHARMD
Individual provider Active NPI Pharmacist · Lincoln, ME
NPI 1629564018 · NPPES record last updated Jul 9, 2018
Key facts
- NPI
- 1629564018
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- PR3743 (ME)
- Practice address
- 250 W Broadway
Lincoln, ME 04457-4006 - Phone
- (207) 794-2055
- Fax
- (207) 794-0220
- NPI assigned
- Jul 9, 2018
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|
| PR3743 | ME | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wal-Mart Stores East LP | Past | Accepting new patients | |
| Wal-Mart Stores East, LP | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PR3743 | ME | Yes |
Addresses
Primary practice location
250 W Broadway
Lincoln, ME 04457-4006
Mailing address
21 Sewall Dr
Old Town, ME 04468-1222
Phone (207) 249-8007
Other providers in Lincoln, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2018. 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.