CVS STATE CAPITAL LLC (NPI# 1104848852) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104848852 |
| Entity Type | Organization |
| Organization Name | CVS STATE CAPITAL LLC |
| Other Organization Name | CVS PHARMACY #16975 |
| Practice Address |
60 Longview Dr Bangor ME 04401-3629 |
| Mailing Address |
1 Cvs Dr Box 1075 Woonsocket RI 02895-6146 |
| Practice Telephone | 2079459977 |
| Practice Fax Number | 2079459977 |
| Mailing Telephone | 4017651500 |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2016-11-08 |
| Authorized Official Name | SUSAN COLBERT (SR. DIRECTOR, PAYER RELATIONS) |
| Authorized Official Telephone | 4017702751 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
PH50001551 | ME | Suppliers |
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| Y | 333600000X | Pharmacy | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2037567 | 01 |
| Other Name | Type Code |
|---|---|
| CVS Pharmacy #16975 | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972789311 | Cvs State Capital LLC | Pharmacy | 119 Crossing Way, Augusta, ME 04330-6102 | 2008-01-16 |
| 1609958073 | Cvs State Capital LLC | Durable Medical Equipment & Medical Supplies | 430 Mariner Way, Biddeford, ME 04005-9440 | 2006-10-19 |
| 1386741866 | Cvs State Capital LLC | Durable Medical Equipment & Medical Supplies | 1096 Brighton Ave, Pine Tree Sc, Portland, ME 04102-1030 | 2006-09-19 |
| 1477650950 | Cvs State Capital LLC | Durable Medical Equipment & Medical Supplies | 10 East Ave Lewiston Sc, Lewiston, ME 04240 | 2006-09-19 |
| 1194822676 | Cvs State Capital LLC | Durable Medical Equipment & Medical Supplies | 1406 Congress St West Gate Sc, Portland, ME 04102 | 2006-09-19 |
| 1235233156 | Cvs State Capital LLC | Durable Medical Equipment & Medical Supplies | 131 Court St, Bath, ME 04530-2054 | 2006-09-12 |
| 1427152347 | Cvs State Capital LLC | Durable Medical Equipment & Medical Supplies | 111 Auburn St, Portland, ME 04103-2103 | 2006-09-12 |
| 1881798700 | Cvs State Capital LLC | Durable Medical Equipment & Medical Supplies | 510 Congress St, Portland, ME 04101-3416 | 2006-09-12 |
| 1063516987 | Cvs State Capital LLC | Pharmacy | 770 Roosevelt Trl, Windham, ME 04062-5300 | 2006-09-12 |
| 1053415976 | Cvs State Capital LLC | Pharmacy | 797 Main St Ste D, Sanford, ME 04073-3536 | 2006-09-12 |
| Street Address |
60 LONGVIEW DR |
| City | BANGOR |
| State | ME |
| Zip Code | 04401-3629 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407231558 | Chrysalis Wild | Pharmacist | 60 Longview Dr, Bangor, ME 04401-3629 | 2015-07-29 |
| 1750715215 | Robert Andrew Whitmore | Pharmacist | 60 Longview Dr, Bangor, ME 04401-3629 | 2013-09-02 |
| 1184969727 | Hansol J Park | Pharmacist | 60 Longview Dr, Bangor, ME 04401-3629 | 2012-12-08 |
| 1609135169 | Nathaniel Warren Breece | Pharmacist | 60 Longview Dr, Bangor, ME 04401-3629 | 2012-05-03 |
| 1073890794 | Andrew Hanscom | Pharmacist | 60 Longview Dr, Bangor, ME 04401-3629 | 2011-11-09 |
| 1588951511 | Kristine Diane Stone | Pharmacist | 60 Longview Dr, Bangor, ME 04401-3629 | 2011-06-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184222523 | Bj's Wholesale Club Inc. | Eyewear Supplier (Equipment, not the service) | 110 Longview Dr, Bangor, ME 04401 | 2020-10-16 |
| 1033737937 | Daniel John Phulman | Counselor | 202 Exchange Street, Bangor, ME 04401 | 2020-07-08 |
| 1770104358 | Elizabeth Sarah Caruson | Physician Assistant | 417 State Street Webber Medical Building, East St, Ste. 121, Bangor, ME 04401 | 2020-05-05 |
| 1053961300 | Erika Dean | Occupational Therapist | 84 Sylvan Rd., Bangor, ME 04401 | 2019-09-18 |
| 1942853635 | Wildworks Therapy, Pllc | Occupational Therapist | 123 Mt Hope Ave, Bangor, ME 04401 | 2019-07-22 |
| 1255999173 | Jessica Arbisi | Physician Assistant | 1 Northeast Drive, Bangor, ME 04401 | 2019-06-05 |
| 1699232041 | Ehab Khamis Elhefnawi | Anesthesiology | Emmc Anesthesia Professional Service, 489 State Street, Bangor, ME 04401 | 2019-02-21 |
| 1477028884 | Zvorufura Makura | Otolaryngology | 885 Union Street, Ste 145, Bangor, ME 04401 | 2018-10-11 |
| 1255826541 | Lindsey M Fields | Optometrist | 955 Broadway Eye Center Northeast Dba Northeast Eyecare, Bangor, ME 04401 | 2018-06-28 |
| 1992211338 | Debra J Mcintyre | Counselor | 157 Park Street, #5, Bangor, ME 04401 | 2017-12-21 |
| Find all providers in zip 04401 | ||||
| Taxonomy Code | 333600000X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: added definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427153600 | M Drug LLC | Pharmacy | 915 Union St Ste 7, Bangor, ME 04401-8604 | 2006-09-13 |
| 1407951676 | M Drug LLC | Pharmacy | 417 State St Ste 130, Bangor, ME 04401-6630 | 2006-09-13 |
| 1427164862 | Slatebelt Drugs Inc | Pharmacy | 435 Blue Valley Dr, Bangor, PA 18013-1513 | 2006-08-21 |
| 1003833377 | Wal-mart Stores East Lp | Pharmacy | 900 Stillwater Ave, Bangor, ME 04401-3602 | 2006-07-16 |
| 1649281155 | M Drug LLC | Pharmacy | 210 State St, Bangor, ME 04401-5411 | 2006-08-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245601061 | Bedard Pharmacy, Inc. | Pharmacy | 5 Horton St, Lewiston, ME 04240-6828 | 2015-10-20 |
| 1811392921 | M Drug LLC | Pharmacy | 401 N Main St Ste A&b, Brewer, ME 04412-1873 | 2014-10-31 |
| 1164849691 | Eastport Family Pharmacy | Pharmacy | 34 Middle St, Eastport, ME 04631 | 2014-03-21 |
| 1588080337 | The Island Employee Cooperative Inc | Pharmacy | 3 Burnt Cove Rd, Stonington, ME 04681-3301 | 2014-03-17 |
| 1679812200 | Frontier Pharmacy LLC | Pharmacy | 153 Bennett Dr, Caribou, ME 04736-2024 | 2013-02-01 |
| 1568759058 | Mt Blue Drug Inc | Pharmacy | 624 Wilton Rd, Farmington, ME 04938-6138 | 2011-07-05 |
| 1417100447 | Procare Pharmacy, L.L.C. | Pharmacy | 141 Preble St, Portland, ME 04101-2440 | 2008-11-04 |
| 1811140841 | Coastal Pharmacy LLC | Pharmacy | 29 Marginal Way, Suite 4, Portland, ME 04101-1914 | 2008-11-04 |
| 1013041557 | Colonial Pharmacy Inc | Pharmacy | 40 Dock Sq, Kennebunkport, ME 04046-6011 | 2007-03-15 |
| 1528196219 | Moosehead Drug Inc. | Pharmacy | 10 Pritham Ave, Greenville, ME 04441 | 2007-03-02 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on CVS STATE CAPITAL LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.