Healthcare Provider Details

I. General information

NPI: 1568580587
Provider Name (Legal Business Name): MACHIAS FRIENDLY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 06/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 OLD COUNTY RD
MARSHFIELD ME
04654-5215
US

IV. Provider business mailing address

PO BOX 9830
SALT LAKE CITY UT
84109-9830
US

V. Phone/Fax

Practice location:
  • Phone: 207-255-6400
  • Fax: 207-255-6410
Mailing address:
  • Phone: 207-255-6400
  • Fax: 207-255-6410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH50001303
License Number StateME

VIII. Authorized Official

Name: PRINCE OGBONNA
Title or Position: PRESIDENT/OWNER
Credential: RPH
Phone: 806-626-1079