Healthcare Provider Details

I. General information

NPI: 1407804537
Provider Name (Legal Business Name): TOGUS VAMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VA CTR
AUGUSTA ME
04330-6719
US

IV. Provider business mailing address

PO BOX 94427
CLEVELAND OH
44101-4427
US

V. Phone/Fax

Practice location:
  • Phone: 207-623-8411
  • Fax: 207-621-4843
Mailing address:
  • Phone: 717-277-6565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332100000X
TaxonomyDepartment of Veterans Affairs (VA) Pharmacy
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2006965
Identifier TypeOTHER
Identifier StateME
Identifier IssuerNCPDP#

VIII. Authorized Official

Name: ERIN POTTER
Title or Position: NPI TEAM MEMBER
Credential:
Phone: 202-382-2579