Provider Demographics
NPI:1841649639
Name:KENNEBEC PHARMACY AND HOME CARE LLC
Entity type:Organization
Organization Name:KENNEBEC PHARMACY AND HOME CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP PHARMACY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCVETY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-626-2726
Mailing Address - Street 1:11 MEDICAL CENTER PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-8158
Mailing Address - Country:US
Mailing Address - Phone:207-626-9066
Mailing Address - Fax:207-621-8016
Practice Address - Street 1:11 MEDICAL CENTER PKWY STE A
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-8158
Practice Address - Country:US
Practice Address - Phone:207-626-9066
Practice Address - Fax:207-621-8016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-13
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X
MEPH50001559333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2160541OtherPK