Provider Demographics
NPI:1770805434
Name:MVH PHARMACY
Entity type:Organization
Organization Name:MVH PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:KASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-622-0075
Mailing Address - Street 1:5 COMMUNITY DRIVE
Mailing Address - Street 2:SUITE 3 MVH PHARMACY
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330
Mailing Address - Country:US
Mailing Address - Phone:207-622-0075
Mailing Address - Fax:207-623-3093
Practice Address - Street 1:5 COMMUNITY DRIVE
Practice Address - Street 2:SUITE 3
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330
Practice Address - Country:US
Practice Address - Phone:207-622-0075
Practice Address - Fax:207-623-3093
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAINE VETERANS' HOMES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPH500013843336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME205184Medicare Oscar/Certification
ME205185Medicare Oscar/Certification
ME205151Medicare Oscar/Certification
ME205126Medicare Oscar/Certification
ME205127Medicare Oscar/Certification