NPIMap

Organization Active NPI

M Drug LLC

Doing business as Northern Light Pharmacy Riverside

  • Community/Retail Pharmacy
  • Bangor, ME
National Provider Identifier
1407951676
Registry record updated Oct 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PH50001488 Issued in ME
Legal business name
M DRUG LLC
Doing business as
Northern Light Pharmacy Riverside
Practice address
417 State St Ste 130
Bangor, ME 04401-6630
Phone
(207) 973-8888
Fax
(207) 973-8891
NPI assigned
Sep 13, 2006
Last updated
Oct 10, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2019

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

Authorized official

Name
Matthew Marston, PHARMD
Title
Director of Pharmacy
Phone
(207) 275-3239

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X PH50001488 ME Primary

Addresses

Primary practice location

417 State St Ste 130
Bangor, ME 04401-6630

Mailing address

PO Box 1779
Bangor, ME 04402-1779
Phone (207) 973-8888

Other identifiers 2

IdentifierTypeStateIssuer
2125120OtherPK
1407951676MedicaidME

Other names 1

  • NORTHERN LIGHT PHARMACY RIVERSIDE Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130129000000 ME Part B Supplier - Mass Immunization (Roster Biller Only) 6305037367 8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bangor, ME; Brewer, ME; Ellsworth, ME; Portland, ME

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570665600000",
    "number": "1407951676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1779",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044021779",
            "telephone_number": "207-973-8888",
            "fax_number": "207-973-8891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 STATE ST STE 130",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044016630",
            "telephone_number": "207-973-8888",
            "fax_number": "207-973-8891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M DRUG LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-13",
        "last_updated": "2019-10-10",
        "status": "A",
        "authorized_official_last_name": "MARSTON",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY",
        "authorized_official_telephone_number": "207-275-3239",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "ME",
            "license": "PH50001488",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2125120",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1407951676",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NORTHERN LIGHT PHARMACY RIVERSIDE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bangor, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.