Provider Demographics
NPI:1003586553
Name:M DRUG LLC
Entity Type:Organization
Organization Name:M DRUG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM-D
Authorized Official - Phone:207-275-1142
Mailing Address - Street 1:931 UNION ST FL 3
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3011
Mailing Address - Country:US
Mailing Address - Phone:207-275-3216
Mailing Address - Fax:
Practice Address - Street 1:295 KENNEDY MEMORIAL DR STE 8
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4535
Practice Address - Country:US
Practice Address - Phone:207-275-3334
Practice Address - Fax:207-275-4830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEPH50001712OtherSTATE OF MAINE BOARD OF PHARMACY