MEDICARE: KENNEBEC PHARMACY & HOME CARE, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

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

General Provider Information

NPI Number	:	1962098848
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENNEBEC PHARMACY & HOME CARE, LLC

Provider Business Mailing Address
First Line	:	43 LEIGHTON RD
Second Line	:
City	:	AUGUSTA
State	:	ME
Zip	:	04330-7705
Country	:	US
Telephone Number	:	207-626-2726
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 ATLANTIC PL UNIT A-12
Second Line	:
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04106-2316
Country	:	US
Telephone Number	:	207-626-2130
Fax Number	:	207-502-8030

Authorized Official
Title or Position	:	CONTROLLER
Name	:	TED NATHAN TREBILCOCK
Credential	:
Telephone Number	:	207-626-2726

Provider Enumeration Date	:	12/15/2020
Last Update Date	:	02/23/2026

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