Provider Demographics
NPI:1114357332
Name:NILES, LAUREN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:
Last Name:NILES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:HENDRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:33 HANNAFORD DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHINA
Mailing Address - State:ME
Mailing Address - Zip Code:04358
Mailing Address - Country:US
Mailing Address - Phone:207-445-3389
Mailing Address - Fax:207-445-3393
Practice Address - Street 1:33 HANNAFORD DRIVE
Practice Address - Street 2:
Practice Address - City:CHINA
Practice Address - State:ME
Practice Address - Zip Code:04358
Practice Address - Country:US
Practice Address - Phone:207-445-3389
Practice Address - Fax:207-445-3393
Is Sole Proprietor?:No
Enumeration Date:2013-11-25
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR12925183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist