Healthcare Provider Details

I. General information

NPI: 1104923028
Provider Name (Legal Business Name): UNIVERSITY OF MAINE SYSTEM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5721 LONG RD
ORONO ME
04469-5721
US

IV. Provider business mailing address

5721 LONG RD
ORONO ME
04469-5721
US

V. Phone/Fax

Practice location:
  • Phone: 207-581-4007
  • Fax: 207-581-4013
Mailing address:
  • Phone: 207-581-4007
  • Fax: 207-581-4013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH50000229
License Number StateME

VIII. Authorized Official

Name: KELLY ESTREMERA
Title or Position: PHARMACY COORDINATOR MANAGER
Credential: RPH
Phone: 207-581-4007