Provider Demographics
NPI:1700125267
Name:MAINE VETERANS' HOMES
Entity Type:Organization
Organization Name:MAINE VETERANS' HOMES
Other - Org Name:MVH PHARMACY (EXTERNAL NON VA BUSINESS)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MCQUAID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-622-0075
Mailing Address - Street 1:5 COMMUNITY DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-8087
Mailing Address - Country:US
Mailing Address - Phone:207-624-0200
Mailing Address - Fax:207-624-0201
Practice Address - Street 1:460 CIVIC CENTER DR STE 1
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-7902
Practice Address - Country:US
Practice Address - Phone:207-624-0200
Practice Address - Fax:207-624-0201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-04
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPH500014573336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2008743OtherNCPDP PROVIDER IDENTIFICATION NUMBER