Cvs State Capital LLC
Pharmacy in Bangor, ME. Organization (NPI-2).
NPI number1104848852
StatusActive
Last updated in NPPESNov 8, 2016
Details
- NPI
- 1104848852
- Entity type
- Organization (NPI-2)
- Legal business name
- Cvs State Capital LLC
- Organization subpart
- No
- Enumeration date
- Jul 24, 2006
- Last updated
- Nov 8, 2016
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · DME SUPPLIER - PHARMACY
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 333600000X | Pharmacy | – | – | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | – | – | |
| 3336C0003X | Pharmacy, Community/Retail Pharmacy | PH50001551 | ME |
Other names
- Cvs Pharmacy #16975 (Doing Business As)
Practice location
60 Longview DrBangor, ME 04401-3629
Phone 207-945-9977 · Fax 207-945-9977
Mailing address
1 Cvs DrBox 1075
Woonsocket, RI 02895-6146
Phone 401-765-1500
Authorized official
Susan Colbert
Sr. Director, Payer Relations
4017702751
Is something wrong?
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