Provider Demographics
NPI:1881681286
Name:COMMUNITY PHARMACIES LLC.
Entity Type:Organization
Organization Name:COMMUNITY PHARMACIES LLC.
Other - Org Name:COMMUNITY PHARMACY-BUCKSPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-621-0698
Mailing Address - Street 1:PO BOX 528
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04332-0528
Mailing Address - Country:US
Mailing Address - Phone:207-621-0698
Mailing Address - Fax:207-622-0952
Practice Address - Street 1:75 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUCKSPORT
Practice Address - State:ME
Practice Address - Zip Code:04416-4025
Practice Address - Country:US
Practice Address - Phone:207-469-7030
Practice Address - Fax:207-469-7035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
MEPH500014123336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1881681286Medicaid
2126871OtherPK
2126871OtherPK