Provider Demographics
NPI:1609216498
Name:DIRIGO DRUG LLC
Entity Type:Organization
Organization Name:DIRIGO DRUG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WICKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-426-6005
Mailing Address - Street 1:PO BOX 284
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:ME
Mailing Address - Zip Code:04927-0284
Mailing Address - Country:US
Mailing Address - Phone:207-426-6005
Mailing Address - Fax:207-426-6007
Practice Address - Street 1:1144 MAIN STREET
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:ME
Practice Address - Zip Code:04927
Practice Address - Country:US
Practice Address - Phone:207-426-6005
Practice Address - Fax:207-426-6007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-26
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPH500014923336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1609216498Medicaid