NPIMap

Organization Active NPI

M Drug LLC

Doing business as Northern Light Pharmacy Fore River

  • Community/Retail Pharmacy
  • Portland, ME
National Provider Identifier
1952856759
Registry record updated Oct 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PH50001645 Issued in ME
Legal business name
M DRUG LLC
Doing business as
Northern Light Pharmacy Fore River
Practice address
195 Fore River Pkwy Ste 170
Portland, ME 04102-2782
Phone
(207) 535-1600
Fax
(207) 535-1610
NPI assigned
Aug 22, 2016
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 J Marston, PHARMD
Title
Director of Pharmacy
Phone
(207) 275-3239

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X PH50001645 ME Primary

Addresses

Primary practice location

195 Fore River Pkwy Ste 170
Portland, ME 04102-2782

Mailing address

PO Box 1779
Bangor, ME 04402-1779
Phone (207) 275-3216

Other identifiers 2

IdentifierTypeStateIssuer
1952856759MedicaidME
2164242OtherPK

Other names 1

  • NORTHERN LIGHT PHARMACY FORE RIVER 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
Tax ID family
M Drug LLC3 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.

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1471824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570665600000",
    "number": "1952856759",
    "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": "207-275-3216",
            "fax_number": "207-561-4804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "195 FORE RIVER PKWY STE 170",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041022782",
            "telephone_number": "207-535-1600",
            "fax_number": "207-535-1610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M DRUG LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-22",
        "last_updated": "2019-10-10",
        "status": "A",
        "authorized_official_last_name": "MARSTON",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "J",
        "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": "PH50001645",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1952856759",
            "state": "ME"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2164242",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NORTHERN LIGHT PHARMACY FORE RIVER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portland, 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.