National Provider Identifier Database

PENOBSCOT INDIAN NATION
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy

An Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy means a pharmacy operated by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization, all of which are defined in Section 4 of the Indian Health Care Improvement Act, 25 U.S.C. 1603.


Contact Information

PENOBSCOT INDIAN NATION
23 WABANAKI WAY
SURRY, ME04468-1252
Phone: 207-817-7400
Fax: 207-817-7452
Website:
Specialty Taxonomy Code
* Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 332800000X

* Indicates primary specialty

NPI Profile & details for PENOBSCOT INDIAN NATION

NPI Number 1699788356
Legal business name
LBN
PENOBSCOT INDIAN NATION
Authorized official PATRICIA KNOX NICOLA - (DIRECTOR)
Entity Organization
Organization subpart No
Enumeration date 08/14/2006
Last updated 10/11/2016 - About 10 years ago
Sole proprietor1 Not specified
Identifiers
  • ME License #: PH50000041
  • ME Medicaid: 106520200
  • Other: 2036350 PK

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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