Healthcare Provider Details

I. General information

NPI: 1467000547
Provider Name (Legal Business Name): JESSICA LYNN TARDIE PHARMD, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2019
Last Update Date: 08/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 CHERRY ST
BURLINGTON VT
05401-3818
US

IV. Provider business mailing address

97 MACHIA HILL RD
WESTFORD VT
05494-9742
US

V. Phone/Fax

Practice location:
  • Phone: 802-862-1562
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number033.0134314
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: