Provider Demographics
NPI:1841880200
Name:WEST MAIN PHARMACY INC
Entity type:Organization
Organization Name:WEST MAIN PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:NADEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-834-2237
Mailing Address - Street 1:1339 ST JOHN RD
Mailing Address - Street 2:
Mailing Address - City:ST JOHN PLT
Mailing Address - State:ME
Mailing Address - Zip Code:04743-4002
Mailing Address - Country:US
Mailing Address - Phone:207-834-2237
Mailing Address - Fax:
Practice Address - Street 1:342 W MAIN ST STE 101B
Practice Address - Street 2:
Practice Address - City:FORT KENT
Practice Address - State:ME
Practice Address - Zip Code:04743-1132
Practice Address - Country:US
Practice Address - Phone:207-316-5272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-20
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy