CVS STATE CAPITAL LLC (NPI# 1386741866) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386741866 |
| Entity Type | Organization |
| Organization Name | CVS STATE CAPITAL LLC |
| Other Organization Name | CVS PHARMACY 00608 |
| Practice Address |
1096 Brighton Ave Pine Tree Sc Portland ME 04102-1030 |
| Mailing Address |
1 Cvs Dr Po Box 1075 Woonsocket RI 02895-6146 |
| Practice Telephone | 2077726201 |
| Enumeration Date | 2006-09-19 |
| Last Update Date | 2012-09-11 |
| Authorized Official Name | SUSAN COLBERT (DIRECTOR) |
| Authorized Official Telephone | 4017651500 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| N | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers | ||
| Y | 333600000X | Pharmacy | PH50000110 | ME | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OTHER ID NUMBER-COMMERCIAL NUMBER | 2003159 | 01 |
| Other Name | Type Code |
|---|---|
| CVS PHARMACY 00608 | 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 |
| 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 |
| 1407950322 | Cvs State Capital LLC | Durable Medical Equipment & Medical Supplies | 335 Ocean House Rd, Cape Elizabeth, ME 04107-2441 | 2006-09-12 |
| Street Address |
1096 BRIGHTON AVE PINE TREE SC |
| City | PORTLAND |
| State | ME |
| Zip Code | 04102-1030 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720602964 | Ci Yen Joanna Man | Student in an Organized Health Care Education/Training Program | 190 Park Ave., Portland, ME 04102 | 2020-06-03 |
| 1841811338 | Abby Zarotny Sahagian | Nurse Anesthetist, Certified Registered | Mmc Anesthesia and Perioperative Medicine, 22 Bramhall St, Portland, ME 04102 | 2020-05-06 |
| 1124656863 | Zachary Bernard Tillett | Student in an Organized Health Care Education/Training Program | Maine Medical Center 22 Bramhall St., Portland, ME 04102 | 2020-03-30 |
| 1215564323 | Joshua Allen Swenson | Student in an Organized Health Care Education/Training Program | 33 Bramhall St, Portland, ME 04102 | 2020-03-26 |
| 1740776434 | Rishi Phakey | Dentist | Community Dental, 190 Park Ave, Portland, ME 04102 | 2018-07-05 |
| 1982192571 | Jessica Thomas | Doula | 619 Brighton Ave #101, Rosemont Wellness Center, Portland, ME 04102 | 2018-04-29 |
| 1699270744 | Shane D Kirkegaard | Student in an Organized Health Care Education/Training Program | Maine Medical Center 22 Bramhall Street, Portland, ME 04102 | 2018-03-29 |
| 1144752494 | Al-shawk Home Healthcare, LLC | Technician | 640 Brighton Ave Ste 8, Portland, ME 04102 | 2017-03-28 |
| 1376074674 | Samuel B Potter | Emergency Medicine | Maine Medical Center, 22 Bramhall Street, Portland, ME 04102 | 2017-03-27 |
| 1043767536 | Kevin De Ruiter | Social Worker | 129 Pine St Apt 6, Portland, ME 04102 | 2016-09-01 |
| Find all providers in zip 04102 | ||||
| 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] |
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| 1972908077 | Zoom Care PC | Pharmacy | 1455 Nw Irving St Ste 500, Portland, OR 97209-2277 | 2014-10-31 |
| 1275946428 | Rite Aid | Pharmacy | 11190 Sw Barnes Dr, Portland, OR 97225 | 2014-06-05 |
| 1033482385 | Strategic Pharmaceutical Solutions Inc | Pharmacy | 17014 Ne Sandy Blvd, Portland, OR 97230-5074 | 2012-02-17 |
| 1811212798 | Luke-dorf, Inc. | Pharmacy | 11349 Ne Sandy Blvd., Portland, OR 97220-1461 | 2010-04-02 |
| 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 |
| Find all providers in PORTLAND | ||||
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| 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.