Provider Demographics
NPI:1689779050
Name:BRUNSWICK MEDICAL CENTER PHARMACY AT SENIOR HEALTH CENTER
Entity Type:Organization
Organization Name:BRUNSWICK MEDICAL CENTER PHARMACY AT SENIOR HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-725-8100
Mailing Address - Street 1:56 BARIBEAU DR
Mailing Address - Street 2:PO BOX 6453
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-3251
Mailing Address - Country:US
Mailing Address - Phone:207-725-8100
Mailing Address - Fax:207-725-7779
Practice Address - Street 1:56 BARIBEAU DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3251
Practice Address - Country:US
Practice Address - Phone:207-725-8100
Practice Address - Fax:207-725-7779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPH50001228332B00000X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME5732150001Medicare ID - Type UnspecifiedOTHER