Provider Demographics
NPI:1114037298
Name:ORONO PHARMACY INC
Entity Type:Organization
Organization Name:ORONO PHARMACY INC
Other - Org Name:ORONO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:207-866-3800
Mailing Address - Street 1:16 MILL ST
Mailing Address - Street 2:
Mailing Address - City:ORONO
Mailing Address - State:ME
Mailing Address - Zip Code:04473-5050
Mailing Address - Country:US
Mailing Address - Phone:207-866-3800
Mailing Address - Fax:207-866-3300
Practice Address - Street 1:16 MILL ST
Practice Address - Street 2:
Practice Address - City:ORONO
Practice Address - State:ME
Practice Address - Zip Code:04473-5050
Practice Address - Country:US
Practice Address - Phone:207-866-3800
Practice Address - Fax:207-866-3300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MEPH500011033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME134390000Medicaid
2037503OtherPK
2037503OtherPK