Organization
SHAWS SUPERMARKETS INC
Active
Other names
SHAWS PHARMACY #4556
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLL MGR)
(208) 395-3954
Entity
Organization
Contact information
Practice address
353 MAIN ST, BANGOR, ME 04401
(207) 945-6550
(207) 945-3361
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH50001480
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
148820001
—
ME
01
—
2037445
PK
—
05
—
999020299
—
ME
Enumeration date
05/26/2006
Last updated
10/01/2024
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