Provider Demographics
NPI:1043306939
Name:CITY PHARMACIES INC
Entity Type:Organization
Organization Name:CITY PHARMACIES INC
Other - Org Name:CITY DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:TALBOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-764-4424
Mailing Address - Street 1:159 ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-3101
Mailing Address - Country:US
Mailing Address - Phone:207-764-4424
Mailing Address - Fax:207-764-4425
Practice Address - Street 1:159 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-3101
Practice Address - Country:US
Practice Address - Phone:207-764-4424
Practice Address - Fax:207-764-4425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336L0003X, 3336S0011X
MEPH500015343336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME103310000Medicaid
2035687OtherPK
0123630001Medicare NSC
2035687OtherPK