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General NPI Number Information
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NPI Number | 1396815106
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Entity Type | Organization
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Legal Business Name | MAINEHEALTH
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | ATTN: RETAIL PHARMACY 6 GLEN COVE DRIVE
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City | ROCKPORT
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State | ME
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Zip | 04856
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Country | US
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Telephone | 207-921-8585
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Fax | 207-921-5274
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Provider Business Mailing Address
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Address Line | ATTN: RETAIL PHARMACY 6 GLEN COVE DRIVE
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City | ROCKPORT
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State | ME
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Zip | 04856
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Country | US
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Telephone | 207-921-8585
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Fax | 207-921-5274
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Authorized Official
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Title or Position | ASSOCIATE CFO
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Name | LUGENE INZANA
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Credential |
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Telephone | 207-661-1346
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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 | PH50001080
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License Number State | ME
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