Provider Demographics
NPI:1831129857
Name:OMNICARE PHARMACY OF MAINE, LLC
Entity type:Organization
Organization Name:OMNICARE PHARMACY OF MAINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:REGIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-392-3300
Mailing Address - Street 1:100 E RIVERCENTER BLVD
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41011-1555
Mailing Address - Country:US
Mailing Address - Phone:859-392-3392
Mailing Address - Fax:
Practice Address - Street 1:99 ENTERPRISE AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:GARDINER
Practice Address - State:ME
Practice Address - Zip Code:04345-6244
Practice Address - Country:US
Practice Address - Phone:207-582-2348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPH500011533336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME=========Medicaid
0498460001Medicare ID - Type Unspecified