Provider Demographics
NPI:1558509588
Name:KENNEBUNK GOOD FOR ALL PHARMACY
Entity Type:Organization
Organization Name:KENNEBUNK GOOD FOR ALL PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGARRIGLE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:207-247-4000
Mailing Address - Street 1:PO BOX 238
Mailing Address - Street 2:
Mailing Address - City:EAST WATERBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04030-0238
Mailing Address - Country:US
Mailing Address - Phone:207-247-4000
Mailing Address - Fax:207-247-4600
Practice Address - Street 1:2 LIVEWELL DR STE 101
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-6763
Practice Address - Country:US
Practice Address - Phone:207-985-9400
Practice Address - Fax:207-985-9499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-29
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MEPH500013533336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2008313OtherNCPDP PROVIDER IDENTIFICATION NUMBER
ME433725000Medicaid
ME433725000Medicaid