Provider Demographics
NPI:1285655233
Name:CITY PHARMACIES INC
Entity Type:Organization
Organization Name:CITY PHARMACIES INC
Other - Org Name:ASHLAND 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:CITY DRUG STORE
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-3101
Mailing Address - Country:US
Mailing Address - Phone:207-435-6200
Mailing Address - Fax:
Practice Address - Street 1:20 PRESQUE ISLE RD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:ME
Practice Address - Zip Code:04732
Practice Address - Country:US
Practice Address - Phone:207-435-6200
Practice Address - Fax:207-435-6131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2016-06-16
Deactivation Date:2009-05-08
Deactivation Code:
Reactivation Date:2014-09-24
Provider Licenses
StateLicense IDTaxonomies
333600000X
MEPH500008223336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME013310000Medicaid
2036343OtherPK
01230001Medicare ID - Type Unspecified