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Contact Information

CVS STATE CAPITAL, L.L.C.
10 MIDDLE ST
FREEPORT, ME04032-1531
 Phone: 207-865-6324
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pharmacy

333600000X 58 Medical Supply Company with Pharmacist
 

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
 

Durable Medical Equipment & Medical Supplies

332B00000X 54 Other Medical Supply Company
Indicates primary specialty

NPI Profile & details for CVS STATE CAPITAL, L.L.C.

NPI Number 1376866830
LBN Legal business name CVS STATE CAPITAL, L.L.C.
Authorized official SUSAN COLBERT - (DIRECTOR, MANAGED CARE CONTRACT ADM)
Entity Organization
Organization subpart 1 No
Enumeration date 03/11/2010
Last updated 06/18/2014 - About 12 years ago
Identifiers
ME Medicaid 157010006
ME Other 2008503 NCPDP
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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