Provider Demographics
NPI:1750463808
Name:CARROLL DRUG STORE INC
Entity Type:Organization
Organization Name:CARROLL DRUG STORE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:W
Authorized Official - Last Name:NORBERG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:207-244-5588
Mailing Address - Street 1:PO BOX 1306
Mailing Address - Street 2:
Mailing Address - City:SOUTHWEST HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04679-1306
Mailing Address - Country:US
Mailing Address - Phone:207-244-5588
Mailing Address - Fax:207-244-5718
Practice Address - Street 1:3 VILLAGE GREEN WAY
Practice Address - Street 2:
Practice Address - City:SOUTHWEST HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04679
Practice Address - Country:US
Practice Address - Phone:207-244-5588
Practice Address - Fax:207-244-5718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPH50001017333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME103650000Medicaid
1011560001Medicare NSC