Healthcare Provider Details

I. General information

NPI: 1861844300
Provider Name (Legal Business Name): CENTRAL MAINE APOTHECARY VENTURES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2016
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 CENTER ST
AUBURN ME
04210-6323
US

IV. Provider business mailing address

300 MAIN ST
LEWISTON ME
04240-7027
US

V. Phone/Fax

Practice location:
  • Phone: 207-784-0807
  • Fax: 207-784-0808
Mailing address:
  • Phone: 207-784-0807
  • Fax: 207-784-0808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH50001561
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KEVIN FORBUSH
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 207-795-2328