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General NPI Number Information
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NPI Number | 1528196219
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Entity Type | Organization
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Legal Business Name | MOOSEHEAD DRUG INC.
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 02/21/2017
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Provider Practice Location Address
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Address Line | 10 PRITHAM AVE
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City | GREENVILLE
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State | ME
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Zip | 04441
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Country | US
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Telephone | 207-695-2921
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Fax | 207-695-3449
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Provider Business Mailing Address
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Address Line | PO BOX 530
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City | GREENVILLE
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State | ME
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Zip | 04441-0530
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | MICHAEL HARRIS
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Credential |
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Telephone | 207-695-2921
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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 | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH50000224
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License Number State | ME
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