Waltz Pharmacy, Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH50001073 Issued in ME

Legal business name

WALTZ PHARMACY, INC

Practice address

5 Friendship St
Waldoboro, ME 04572

Phone

(207) 832-5511

Fax

(207) 832-8130

NPI assigned

Dec 5, 2006

Last updated

Nov 3, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dean Jacobs, RPH

Title

President

Phone

(866) 415-1954

Specialties & licenses 2

Addresses

Other identifiers 2

Tax ID family

Camden Drug Co3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Waltz Pharmacy, Inc

  • Community/Retail Pharmacy
  • Belfast, ME
  • NPI 1730247339
  NPD tax ID
• Waltz Pharmacy, Inc

  dba Pittsfield Pharmacy

  • Community/Retail Pharmacy
  • Pittsfield, ME
  • NPI 1851459465
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225670400000",
    "number": "1285792655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 130",
            "city": "CAMDEN",
            "state": "ME",
            "postal_code": "048430130",
            "telephone_number": "207-230-1053",
            "fax_number": "207-230-0039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 FRIENDSHIP ST",
            "city": "WALDOBORO",
            "state": "ME",
            "postal_code": "04572",
            "telephone_number": "207-832-5511",
            "fax_number": "207-832-8130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALTZ PHARMACY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-05",
        "last_updated": "2008-11-03",
        "status": "A",
        "authorized_official_last_name": "JACOBS",
        "authorized_official_first_name": "DEAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "866-415-1954",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "ME",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "ME",
            "license": "PH50001073",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101460008",
            "state": "ME"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP#",
            "identifier": "2002258",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lisa Michelle Stout, DO
• Debra A Tillou, D.C.
• Town of Waldoboro
• Kurt Arthur Vreeland, DC,DIBAK,DIBCN
• Waldoboro Chiropractic Center PA
• Emily Waltz, BS
• Jack L Waterman, M.D.
• Margaret H Webb, MD
• Alicia Willette-Cook
• Tiffany Alaina Willey, LMT

• Community/Retail Pharmacy in Waldoboro, ME
• Providers in Waldoboro, ME by specialty
• Community/Retail Pharmacy in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.