Healthcare Provider Details

I. General information

NPI: 1417932153
Provider Name (Legal Business Name): ELAINE YOUNG METZGER PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 05/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 SHELBURNE RD
BURLINGTON VT
05401
US

IV. Provider business mailing address

595 SHELBURNE RD
BURLINGTON VT
05401-5050
US

V. Phone/Fax

Practice location:
  • Phone: 802-651-9835
  • Fax:
Mailing address:
  • Phone: 802-651-9535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number033.00003790
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: