Spruce Mountain Pharmacy Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH50001356 Issued in ME

Legal business name

SPRUCE MOUNTAIN PHARMACY INC.

Practice address

148 Main St
Jay, ME 04239-1506

Phone

(207) 897-9080

Fax

(207) 897-9082

NPI assigned

Jan 27, 2009

Last updated

Sep 18, 2020By 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

Mr. Stephen J Maki, RPHNPI 1083277933

Title

President/Pharmacist

Phone

(207) 645-5058

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ME

Enrollment records 1

Tax ID family

Spruce Mountain Pharmacy Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Spruce Mountain Pharmacy Inc.

  • Long Term Care Pharmacy
  • Jay, ME
  • NPI 1649008541
  NPD tax ID

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Stephen Maki, RPH

  • Pharmacy
  • Jay, ME
  • NPI 1083277933
  NPD Authorized official
• Julia M Annis, PHARMD

  • Pharmacist
  • Redmond, OR
  • NPI 1003545153
  NPD

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

{
    "created_epoch": "1233014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600387200000",
    "number": "1831337088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "148 MAIN ST",
            "city": "JAY",
            "state": "ME",
            "postal_code": "042391506",
            "telephone_number": "207-897-9080",
            "fax_number": "207-897-9082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "148 MAIN ST",
            "city": "JAY",
            "state": "ME",
            "postal_code": "042391506",
            "telephone_number": "207-897-9080",
            "fax_number": "207-897-9082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPRUCE MOUNTAIN PHARMACY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-27",
        "last_updated": "2020-09-18",
        "certification_date": "2020-09-18",
        "status": "A",
        "authorized_official_last_name": "MAKI",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT/PHARMACIST",
        "authorized_official_telephone_number": "207-645-5058",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "ME",
            "license": "PH50001356",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "433815200",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• QL Therapy LLC
• Samantha Rae Ring
• Camden Saucier, PHARM D
• Smartworks Inc
• Spruce Mountain Pharmacy Inc.
• Cory St Denis, D.C.
• James Michael St. Jean, P.T.
• Town of Jay, Jay School Department
• Thomas Ventrella

• Community/Retail Pharmacy in Jay, ME
• Providers in Jay, 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 Sep 18, 2020; 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.