Healthcare Provider Details

I. General information

NPI: 1871076117
Provider Name (Legal Business Name): AROOSTOOK APOTHECARY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2018
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 PRESQUE ISLE ROAD
ASHLAND ME
04732
US

IV. Provider business mailing address

159 ACADEMY ST
PRESQUE ISLE ME
04769-3101
US

V. Phone/Fax

Practice location:
  • Phone: 207-435-6200
  • Fax: 207-435-6131
Mailing address:
  • Phone: 207-764-4424
  • Fax: 207-764-4425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW TALBOT
Title or Position: PRESIDENT
Credential:
Phone: 207-435-6200