Provider Demographics
NPI:1659476836
Name:AFFILIATED PHARMACY SERVICES
Entity Type:Organization
Organization Name:AFFILIATED PHARMACY SERVICES
Other - Org Name:AIRLINE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENOR IS ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-973-6684
Mailing Address - Street 1:405 N MAIN ST
Mailing Address - Street 2:NORTH MAIN ST SHOPPING CTR
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1877
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:405 N MAIN ST
Practice Address - Street 2:NORTH MAIN ST SHOPPING CTR
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-1877
Practice Address - Country:US
Practice Address - Phone:207-989-2424
Practice Address - Fax:207-989-6060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MEPH500011053336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2007397OtherOTHER ID NUMBER
5805100003Medicare NSC