Provider Demographics
NPI:1487668927
Name:KENNEBEC PHARMACY AND HOME CARE LLC
Entity Type:Organization
Organization Name:KENNEBEC PHARMACY AND HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT OF PHARMACY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-373-3300
Mailing Address - Street 1:43 LEIGHTON RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-7705
Mailing Address - Country:US
Mailing Address - Phone:207-626-2726
Mailing Address - Fax:207-626-8163
Practice Address - Street 1:43 LEIGHTON RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-7705
Practice Address - Country:US
Practice Address - Phone:207-626-2726
Practice Address - Fax:207-626-8163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME251F00000X, 332B00000X, 332BP3500X, 332BX2000X, 333600000X, 3336C0003X, 3336H0001X, 3336S0011X, 335E00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No251F00000XAgenciesHome Infusion
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME040456OtherANTHEM DME
ME129010001Medicaid
ME2354823OtherAETNA DME
ME129010002Medicaid
ME2173534OtherAETNA HOME INFUSION
ME702221OtherHARVARD PILGRIM
ME017768OtherANTHEM HOME INFUSION
ME2006294OtherNABP
ME129010002Medicaid
ME2354823OtherAETNA DME
MEBK4490277OtherDEA