Provider Demographics
NPI:1174110415
Name:NELSON, DARREN (PHARMD)
Entity type:Individual
Prefix:
First Name:DARREN
Middle Name:
Last Name:NELSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 143
Mailing Address - Street 2:
Mailing Address - City:UNITY
Mailing Address - State:ME
Mailing Address - Zip Code:04988-0143
Mailing Address - Country:US
Mailing Address - Phone:207-948-3950
Mailing Address - Fax:207-948-5658
Practice Address - Street 1:33 PLAZA DR
Practice Address - Street 2:
Practice Address - City:UNITY
Practice Address - State:ME
Practice Address - Zip Code:04988-3917
Practice Address - Country:US
Practice Address - Phone:207-948-3950
Practice Address - Fax:207-948-5658
Is Sole Proprietor?:No
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR5521183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist