Provider Demographics
NPI:1437411709
Name:QUODDY BAY PHARMACY
Entity Type:Organization
Organization Name:QUODDY BAY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:R
Authorized Official - Last Name:AGHAMOOSA
Authorized Official - Suffix:
Authorized Official - Credentials:
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 1:88 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:EASTPORT
Practice Address - State:ME
Practice Address - Zip Code:04631-1229
Practice Address - Country:US
Practice Address - Phone:207-866-3800
Practice Address - Fax:207-866-3300
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORONO PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPH500014543336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy