Organization
WALTZ PHARMACY, INC
Active
Parent organization
WALTZ PHARMACY, INC
Other names
PITTSFIELD PHARMACY
Organization subpart
Yes
Provider details
NPI number
Legal business name
WALTZ PHARMACY, INC
Authorized official
DEAN JACOBS RPH (PRESIDENT)
(207) 230-1053
Entity
Organization
Contact information
Practice address
166 NORTH MAIN STREET, PITTSFIELD, ME 04967
(207) 487-5424
(207) 487-5626
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
PH50001224
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003012
ANTHEM HME PROVIDER #
ME
01
—
2006915
NABP#
ME
Enumeration date
12/05/2006
Last updated
07/24/2007
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