Organization
WALTZ PHARMACY, INC
Active
Organization
WALTZ PHARMACY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEAN JACOBS RPH (PRESIDENT)
(866) 415-1954
Entity
Organization
Contact information
Practice address
167 MAIN STREET, DAMARISCOTTA, ME 04543-4649
(207) 563-3128
(207) 563-3063
Mailing address
PO BOX 130, CAMDEN, ME 04843-0130
(207) 230-1053
(207) 230-0039
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
ME
3336C0003X
Community/Retail Pharmacy
Primary
PH50000057
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003012
BLUE CROSS PROVIDER ID#
ME
05
—
101460006
—
ME
01
—
2001624
NABP#
ME
Enumeration date
12/05/2006
Last updated
11/11/2008
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