Provider Demographics
NPI:1962098848
Name:KENNEBEC PHARMACY & HOME CARE, LLC
Entity type:Organization
Organization Name:KENNEBEC PHARMACY & HOME CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP HOME CARE
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUCETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-626-2726
Mailing Address - Street 1:43 LEIGHTON RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-7705
Mailing Address - Country:US
Mailing Address - Phone:207-626-2726
Mailing Address - Fax:
Practice Address - Street 1:12 ATLANTIC PL UNIT 12-A
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2316
Practice Address - Country:US
Practice Address - Phone:207-626-2130
Practice Address - Fax:207-502-8030
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENNEBEC PHARMACY & HOME CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-15
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME129010001Medicaid