Provider Demographics
NPI:1417662255
Name:PRESQUE ISLE PHARMACY CO., LLC
Entity Type:Organization
Organization Name:PRESQUE ISLE PHARMACY CO., LLC
Other - Org Name:PRESQUE ISLE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KYLIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-760-9100
Mailing Address - Street 1:797 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-2201
Mailing Address - Country:US
Mailing Address - Phone:207-760-9100
Mailing Address - Fax:207-760-9191
Practice Address - Street 1:797 MAIN ST
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-2201
Practice Address - Country:US
Practice Address - Phone:207-760-9100
Practice Address - Fax:207-760-9191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-17
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy