Active NPI
M Drug LLC
- Community/Retail Pharmacy
- Bangor, ME
National Provider Identifier
1649281155
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- PH50001487
- Legal business name
- M DRUG LLC
- Practice address
- 210 State St
Bangor, ME 04401-5411 - Phone
- (207) 947-8369
- Fax
- (207) 947-0894
- NPI assigned
- Aug 10, 2006
- Organization subpart
- No
NPPES NPI Registry
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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | PH50001487 | ME | Primary |
| Compounding Pharmacy | 3336C0004X |
Addresses
Primary practice location
210 State St
Bangor, ME 04401-5411
Mailing address
PO Box 1779
Bangor, ME 04402-1779
Phone (207) 947-8369
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2125071 | Other | PK |
Other names 1
- NORTHERN LIGHT PHARMACY STATE STREET
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ME
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130129000000 | ME | Part B Supplier - Mass Immunization (Roster Biller Only) | 6305037367 |
8 other NPIs on this enrollment Practice locations: Bangor, ME; Brewer, ME; Ellsworth, ME; Portland, ME |
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
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 DirectoryMember of 1
Organizations this organization is a member of, according to the National Provider Directory.
Locations
210 State St
Bangor, ME 04401
Phone (207) 947-8363
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155168000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1570665600000",
"number": "1649281155",
"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": "207-947-8369",
"fax_number": "207-561-4803"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 STATE ST",
"city": "BANGOR",
"state": "ME",
"postal_code": "044015411",
"telephone_number": "207-947-8369",
"fax_number": "207-947-0894"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "M DRUG LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-08-10",
"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": null,
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "ME",
"license": "PH50001487",
"primary": true
},
{
"code": "3336C0004X",
"taxonomy_group": "",
"desc": "Pharmacy, Compounding Pharmacy",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2125071",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "NORTHERN LIGHT PHARMACY STATE STREET",
"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.