Healthcare Provider Details

I. General information

NPI: 1336200401
Provider Name (Legal Business Name): GREATER FALLS PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 ATKINSON STREET
BELLOWS FALLS VT
05101
US

IV. Provider business mailing address

78 ATKINSON STREET
BELLOWS FALLS VT
05101
US

V. Phone/Fax

Practice location:
  • Phone: 802-460-2634
  • Fax: 802-460-2296
Mailing address:
  • Phone: 802-460-2634
  • Fax: 802-460-2296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE L. LAURENDEAU
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 802-460-2634