Organization
M DRUG LLC
Active
Other names
NORTHERN LIGHT PHARMACY STATE STREET
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW MARSTON PHARMD (DIRECTOR OF PHARMACY)
(207) 275-3239
Entity
Organization
Contact information
Practice address
210 STATE ST, BANGOR, ME 04401-5411
(207) 947-8369
(207) 947-0894
Mailing address
PO BOX 1779, BANGOR, ME 04402-1779
(207) 947-8369
(207) 561-4803
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH50001487
ME
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2125071
PK
—
Enumeration date
08/10/2006
Last updated
10/10/2019
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