Active NPI
Lisa M Libby
- Pharmacist
- Waterville, ME
National Provider Identifier
1760088868
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PR5633
- Practice address
- 1 Kennedy Memorial Dr
Waterville, ME 04901-5125 - Phone
- (207) 873-7161
- NPI assigned
- Dec 5, 2020
- Last updated
- Dec 5, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PR5633 | ME | Primary |
Addresses
Primary practice location
1 Kennedy Memorial Dr
Waterville, ME 04901-5125
Mailing address
62 Riva Ridge Rd
Vassalboro, ME 04989-3245
Phone (207) 313-0918
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PR5633 | ME | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CVS State Capital LLC | Past | Accepting new patients | |
| CVS State Capital LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1607126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1607126400000",
"number": "1760088868",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "62 RIVA RIDGE RD",
"city": "VASSALBORO",
"state": "ME",
"postal_code": "049893245",
"telephone_number": "207-313-0918"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 KENNEDY MEMORIAL DR",
"city": "WATERVILLE",
"state": "ME",
"postal_code": "049015125",
"telephone_number": "207-873-7161"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIBBY",
"first_name": "LISA",
"middle_name": "M",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-12-05",
"last_updated": "2020-12-05",
"certification_date": "2020-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ME",
"license": "PR5633",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waterville, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.