Provider Demographics
NPI:1790368603
Name:KENNEBEC PHARMACY & HOME CARE, LLC
Entity Type:Organization
Organization Name:KENNEBEC PHARMACY & HOME CARE, LLC
Other - Org Name:KENNEBEC PHARMACY & HOME CARE,LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF HOME CARE
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUCETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-626-2726
Mailing Address - Street 1:219 MOUNT AUBURN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210
Mailing Address - Country:US
Mailing Address - Phone:207-626-2726
Mailing Address - Fax:207-626-8163
Practice Address - Street 1:219 MOUNT AUBURN AVE SUITE B
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-8521
Practice Address - Country:US
Practice Address - Phone:207-626-2120
Practice Address - Fax:207-626-8163
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENNEBEC PHARMACY & HOME CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-29
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies