Provider Demographics
NPI:1104332691
Name:NIKORNPAN, KATRINA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:
Last Name:NIKORNPAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:KATRINA
Other - Middle Name:
Other - Last Name:MORAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:283 WATER ST STE 401
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-4748
Mailing Address - Country:US
Mailing Address - Phone:207-592-1082
Mailing Address - Fax:
Practice Address - Street 1:9 SPRING ST
Practice Address - Street 2:
Practice Address - City:GARDINER
Practice Address - State:ME
Practice Address - Zip Code:04345-1823
Practice Address - Country:US
Practice Address - Phone:207-582-3051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR47048183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist