Organization
MT BLUE DRUG INC
Active
Other names
Mt Blue Drug
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTY KRASNAVAGE (OWNER)
(207) 474-3393
Entity
Organization
Contact information
Practice address
624 WILTON RD, FARMINGTON, ME 04938-6138
(207) 778-5419
(207) 778-5983
Mailing address
12 HIGH ST, SKOWHEGAN, ME 04976-1815
(207) 474-3393
(207) 474-7541
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH50001429
ME
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
169480000
—
ME
Enumeration date
07/05/2011
Last updated
10/03/2025
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