Provider Demographics
NPI:1750499000
Name:J H HARVEY CO LLC
Entity Type:Organization
Organization Name:J H HARVEY CO LLC
Other - Org Name:HARVEYS SUPERMARKET PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THIRD PARTY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CURRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-885-3161
Mailing Address - Street 1:PO BOX 1000 MSC 3000
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04104-5005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:620 FAIR RD
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-4927
Practice Address - Country:US
Practice Address - Phone:912-681-1941
Practice Address - Fax:912-681-3684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE008913333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1152949OtherOTHER ID NUMBER-COMMERCIAL NUMBER
5085310010Medicare ID - Type Unspecified