Organization
M DRUG LLC
Active
Other names
NORTHERN LIGHT PHARMACY FORE RIVER
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW J MARSTON PHARMD (DIRECTOR OF PHARMACY)
(207) 275-3239
Entity
Organization
Contact information
Practice address
195 FORE RIVER PKWY STE 170, PORTLAND, ME 04102-2782
(207) 535-1600
(207) 535-1610
Mailing address
PO BOX 1779, BANGOR, ME 04402-1779
(207) 275-3216
(207) 561-4804
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH50001645
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1952856759
—
ME
01
—
2164242
PK
—
Enumeration date
08/22/2016
Last updated
10/10/2019
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