Provider Demographics
NPI:1093889511
Name:HEBERT REXALL PHARMACY INC
Entity Type:Organization
Organization Name:HEBERT REXALL PHARMACY INC
Other - Org Name:HEBERT REXALL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMD
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEBERT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:207-868-2242
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:ME
Mailing Address - Zip Code:04785-0220
Mailing Address - Country:US
Mailing Address - Phone:207-868-2242
Mailing Address - Fax:207-868-2156
Practice Address - Street 1:31 MAIN ST
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:ME
Practice Address - Zip Code:04785-1012
Practice Address - Country:US
Practice Address - Phone:207-868-2242
Practice Address - Fax:207-868-2156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0003X
MEPH500014593336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME104230000Medicaid
2138841OtherPK
ME0170600001Medicare NSC