Organization
SHAWS SUPERMARKETS INC
Active
Other names
Shaws Pharmacy #4559
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
27 EAST AVE, LEWISTON, ME 04240
(207) 784-6666
(207) 784-3155
Mailing address
250 E PARKCENTER BLVD, MAILSTOP SEC2-B, BOISE, ID 83706-3940
(208) 395-6200
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH50001471
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
148820007
—
ME
01
—
2037526
PK
—
05
—
999111017
—
ME
Enumeration date
05/26/2006
Last updated
10/04/2024
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