Provider Demographics
NPI:1487067997
Name:SEASIDE PHARMACY
Entity type:Organization
Organization Name:SEASIDE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT, CFO
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:EDINGER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:207-367-2575
Mailing Address - Street 1:PO BOX 649
Mailing Address - Street 2:59 SCHOOL STREET
Mailing Address - City:STONINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04681-0649
Mailing Address - Country:US
Mailing Address - Phone:207-367-2575
Mailing Address - Fax:207-367-2570
Practice Address - Street 1:59 SCHOOL STREET
Practice Address - Street 2:
Practice Address - City:STONINGTON
Practice Address - State:ME
Practice Address - Zip Code:04681
Practice Address - Country:US
Practice Address - Phone:207-367-2575
Practice Address - Fax:207-367-2570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-03
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME7357410001Medicare NSC