MEDICARE: HOTEL PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	0380000565	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4700565	OTHER	NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1225031800
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOTEL PHARMACY INC

Provider Business Mailing Address
First Line	:	20 ELLIOT ST
Second Line	:	NO 1
City	:	BRATTLEBORO
State	:	VT
Zip	:	05301-3216
Country	:	US
Telephone Number	:	802-254-2303
Fax Number	:	802-257-0023

Provider Business Practice Location Address
First Line	:	20 ELLIOT ST
Second Line	:	NO 1
City	:	BRATTLEBORO
State	:	VT
Zip	:	05301-3216
Country	:	US
Telephone Number	:	802-254-2303
Fax Number	:	802-257-0023

Authorized Official
Title or Position	:	OWNER AND PRESIDENT
Name	:	MARY GIAMARTINO
Credential	:	RPH
Telephone Number	:	802-254-2303

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	02/16/2010

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Directions to “HOTEL PHARMACY INC ” Practice Location

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