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General NPI Number Information
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NPI Number | 1306129085
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Entity Type | Organization
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Legal Business Name | WESTERN MAINE PHARMACY INC
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Dates
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Enumeration Date | 09/20/2011
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Last Update Date | 12/16/2021
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Provider Practice Location Address
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Address Line | 119 MAIN ST
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City | KINGFIELD
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State | ME
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Zip | 04947-4229
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Country | US
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Telephone | 207-265-8020
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Fax | 207-265-8022
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Provider Business Mailing Address
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Address Line | PO BOX 64
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City | KINGFIELD
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State | ME
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Zip | 04947-0064
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Country | US
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Telephone | 207-265-8020
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Fax | 207-265-8022
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Authorized Official
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Title or Position | PRESIDENT
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Name | AUDREY GOULD
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Credential |
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Telephone | 207-265-8020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH50001437
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License Number State | ME
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