Organization
SPRUCE MOUNTAIN PHARMACY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN J MAKI RPH (PRESIDENT/PHARMACIST)
(207) 645-5058
Entity
Organization
Contact information
Practice address
148 MAIN ST, JAY, ME 04239-1506
(207) 897-9080
(207) 897-9082
Mailing address
148 MAIN ST, JAY, ME 04239-1506
(207) 897-9080
(207) 897-9082
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PH50001356
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
433815200
—
ME
Enumeration date
01/27/2009
Last updated
09/18/2020
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