Provider Demographics
NPI:1710992342
Name:KENNEBEC PHARMACY AND HOME CARE LLC
Entity Type:Organization
Organization Name:KENNEBEC PHARMACY AND HOME CARE LLC
Other - Org Name:KENNEBEC PHARMACY & HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MCVETY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH MBA
Authorized Official - Phone:207-626-2726
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 1:839 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-4243
Practice Address - Country:US
Practice Address - Phone:207-594-0888
Practice Address - Fax:207-594-0889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
MEPH500012483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME129010002Medicaid
2037593OtherPK
1010410002Medicare NSC