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General NPI Number Information
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NPI Number | 1831337088
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Entity Type | Organization
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Legal Business Name | SPRUCE MOUNTAIN PHARMACY INC.
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Dates
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Enumeration Date | 01/27/2009
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Last Update Date | 09/18/2020
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Provider Practice Location Address
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Address Line | 148 MAIN ST
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City | JAY
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State | ME
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Zip | 04239-1506
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Country | US
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Telephone | 207-897-9080
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Fax | 207-897-9082
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Provider Business Mailing Address
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Address Line | 148 MAIN ST
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City | JAY
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State | ME
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Zip | 04239-1506
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Country | US
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Telephone | 207-897-9080
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Fax | 207-897-9082
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Authorized Official
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Title or Position | PRESIDENT/PHARMACIST
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Name | MR. STEPHEN J MAKI
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Credential | RPH
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Telephone | 207-645-5058
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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 | PH50001356
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License Number State | ME
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