Organization
NORTHERN MAINE MEDICAL CENTER
Active
Other names
ST JOHN VALLEY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
AARON TEACHOUT (CFO)
(207) 834-1820
Entity
Organization
Contact information
Practice address
182 MARKET ST, STE 2, FORT KENT, ME 04743
(207) 834-2880
(207) 834-2882
Mailing address
PO BOX 189, FORT KENT, ME 04743
(207) 834-2880
(207) 834-2882
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH50001216
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2037573
PK
—
05
—
424260000
—
ME
Enumeration date
08/13/2005
Last updated
03/25/2025
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