Provider Demographics
NPI:1407897366
Name:YORK HOSPITAL BERWICK PHARMACY
Entity Type:Organization
Organization Name:YORK HOSPITAL BERWICK PHARMACY
Other - Org Name:YORK HOSPITAL BERWICK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARM
Authorized Official - Phone:207-351-2314
Mailing Address - Street 1:4 DANA LN
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:ME
Mailing Address - Zip Code:03901-2767
Mailing Address - Country:US
Mailing Address - Phone:207-698-6740
Mailing Address - Fax:207-698-6749
Practice Address - Street 1:4 DANA LN
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:ME
Practice Address - Zip Code:03901-2767
Practice Address - Country:US
Practice Address - Phone:207-698-6740
Practice Address - Fax:207-698-6749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MEPH500012363336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2037586OtherPK
ME1407897366Medicaid
NH30706562Medicaid