Healthcare Provider Details

I. General information

NPI: 1750463808
Provider Name (Legal Business Name): CARROLL DRUG STORE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 10/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 VILLAGE GREEN WAY
SOUTHWEST HARBOR ME
04679
US

IV. Provider business mailing address

PO BOX 1306
SOUTHWEST HARBOR ME
04679-1306
US

V. Phone/Fax

Practice location:
  • Phone: 207-244-5588
  • Fax: 207-244-5718
Mailing address:
  • Phone: 207-244-5588
  • Fax: 207-244-5718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH50001017
License Number StateME

VIII. Authorized Official

Name: MR. ERIC W NORBERG
Title or Position: PHARMACIST PRESIDENT
Credential: RPH
Phone: 207-244-5588