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General NPI Number Information
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NPI Number | 1780913111
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Entity Type | Organization
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Legal Business Name | M DRUG LLC
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Dates
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Enumeration Date | 12/14/2009
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Last Update Date | 10/10/2019
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Provider Practice Location Address
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Address Line | 33 WHITING HILL RD STE 4
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City | BREWER
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State | ME
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Zip | 04412-1022
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Country | US
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Telephone | 207-973-9444
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Fax | 207-973-9441
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Provider Business Mailing Address
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Address Line | PO BOX 1779
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City | BANGOR
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State | ME
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Zip | 04402-1779
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Country | US
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Telephone | 207-275-3211
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Fax | 207-561-4803
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | MATTHEW J MARSTON
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Credential | PHARMD
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Telephone | 207-275-3239
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH50001489
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License Number State | ME
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