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Contact Information

MT BLUE DRUG INC
624 WILTON RD
FARMINGTON, ME04938-6138
 Phone: 207-778-5419
 Fax: 207-778-5983
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
 

Long Term Care Pharmacy

3336L0003X 58 Medical Supply Company with Pharmacist
 

Pharmacy

333600000X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for MT BLUE DRUG INC

NPI Number 1568759058
LBN Legal business name MT BLUE DRUG INC
Authorized official KRISTY KRASNAVAGE - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 07/05/2011
Last updated 10/03/2025 - About 8 months ago
Identifiers
ME License # PH50001429
ME Medicaid 169480000
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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