Healthcare Provider Details

I. General information

NPI: 1861175622
Provider Name (Legal Business Name): HANNAFORD BROS. CO., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2023
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 PAYNE RD
SCARBOROUGH ME
04074-9594
US

IV. Provider business mailing address

PO BOX 1000
PORTLAND ME
04104-5005
US

V. Phone/Fax

Practice location:
  • Phone: 207-883-0104
  • Fax: 207-883-0122
Mailing address:
  • Phone: 207-885-7454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL VAIL
Title or Position: PRESIDENT
Credential:
Phone: 207-885-7454