Organization Name:  KENNEBEC PHARMACY AND HOME CARE LLC


Practice Location:
43 LEIGHTON RD  AUGUSTA, ME 04330 US
Tel: 207-626-2726  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

Primary	Code	Category/Description	State	License Number
N	3336S0011X	Suppliers Pharmacy Specialty Pharmacy	ME	=========
N	335E00000X	Suppliers Prosthetic/Orthotic Supplier	ME	=========
N	251F00000X	Agencies Home Infusion	ME	=========
N	332B00000X	Suppliers Durable Medical Equipment & Medical Supplies	ME	=========
N	332B00000X	Suppliers Durable Medical Equipment & Medical Supplies
N	332BX2000X	Suppliers Durable Medical Equipment & Medical Supplies	ME	=========
N	333600000X	Suppliers Pharmacy	ME	=========
N	3336C0003X	Suppliers Pharmacy	ME	=========
N	3336H0001X	Suppliers Pharmacy	ME	=========
Y	332BP3500X	Suppliers Durable Medical Equipment & Medical Supplies	ME	=========

Other Provider Identifiers:

Issuer	Number	State	Type
ANTHEM DME	040456	ME	01
HARVARD PILGRIM	702221	ME	01
ANTHEM HOME INFUSION	017768	ME	01
DEA	BK4490277	ME	01
	129010001	ME	05
	129010002	ME	05
AETNA HOME INFUSION	2173534	ME	01
NABP	2006294	ME	01
AETNA DME	2354823	ME	01

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin