Healthcare Provider Details

I. General information

NPI: 1538616776
Provider Name (Legal Business Name): PHILIP KRAMER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2016
Last Update Date: 09/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 CANAL ST
BRATTLEBORO VT
05301-7112
US

IV. Provider business mailing address

PO BOX 8344
BRATTLEBORO VT
05304-8344
US

V. Phone/Fax

Practice location:
  • Phone: 802-257-4204
  • Fax:
Mailing address:
  • Phone: 802-275-5062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number033.0003147
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: