MEDICARE: FOOD LION, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	332BC3200X	Customized Equipment (DME)
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3465071	OTHER		NCPDP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164800355
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOD LION, LLC

Provider Business Mailing Address
First Line	:	PO BOX 1000
Second Line	:	MS 3000
City	:	PORTLAND
State	:	ME
Zip	:	04104-5005
Country	:	US
Telephone Number	:	207-885-7454
Fax Number	:

Provider Business Practice Location Address
First Line	:	1419 E ANDREWS AVE
Second Line	:
City	:	HENDERSON
State	:	NC
Zip	:	27536-5202
Country	:	US
Telephone Number	:	252-762-0156
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARGARET M HAM
Credential	:
Telephone Number	:	207-885-7454

Provider Enumeration Date	:	05/08/2015
Last Update Date	:	05/10/2017

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