Healthcare Provider Details

I. General information

NPI: 1497863872
Provider Name (Legal Business Name): MARTINS FOODS OF SOUTH BURLINGTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2006
Last Update Date: 09/19/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 TED DR
PINE BUSH NY
12566-7032
US

IV. Provider business mailing address

PO BOX 1000 MS 3000
PORTLAND ME
04104-5005
US

V. Phone/Fax

Practice location:
  • Phone: 845-744-4827
  • Fax: 845-744-8948
Mailing address:
  • Phone: 207-885-7454
  • Fax: 704-645-6531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number026403
License Number StateNY

VIII. Authorized Official

Name: MICHAEL VAIL
Title or Position: PRESIDENT AND MANAGER
Credential:
Phone: 207-885-7454