Organization
WALTZ PHARMACY, INC
Active
Organization
WALTZ PHARMACY, INC
Active
Other names
WALTZ HOME MEDICAL SUPPLIES
Organization subpart
No
Provider details
NPI number
Authorized official
DEAN JACOBS RPH (PRESIDENT)
(866) 415-1954
Entity
Organization
Contact information
Practice address
83 ELM ST, CAMDEN, ME 04843-1942
(207) 236-2240
(207) 236-9489
Mailing address
PO BOX 130, CAMDEN, ME 04843-0130
(207) 236-2240
(207) 236-9489
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003012
ANTHEM BLUE CROSS ID#
ME
01
—
048613
BLUE CROSS
ME
05
—
101460005
—
ME
Enumeration date
12/18/2006
Last updated
11/11/2008
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