| NPI | 1184645921 |
|---|---|
| Doing Business As | ST JOHN VALLEY LTC |
| Entity Type | Organization |
| Authorized Contact | CHARLES OUELLETTE Owner 207-834-2880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy, Long Term Care Pharmacy (Licence: ME PH50001240) |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2018-05-08 |