Organization
PENOBSCOT COMMUNITY HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORI L. DWYER ESQ. (PRESIDENT & CEO)
(207) 992-9200
Entity
Organization
Contact information
Practice address
242 BRUNSWICK ST, OLD TOWN, ME 04468-1613
(207) 992-4100
(207) 827-8391
Mailing address
PO BOX 2100, BANGOR, ME 04402-2100
(207) 945-5247
(207) 827-8391
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH50001432
ME
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
131160301
—
ME
01
—
2037653
PK
—
Enumeration date
10/16/2007
Last updated
01/19/2018
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