Healthcare Provider Details

I. General information

NPI: 1366754962
Provider Name (Legal Business Name): STACY EMILY BRUYNS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2010
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 S MAIN ST
CAMBRIDGE VT
05444-9665
US

IV. Provider business mailing address

3 RAYMOND DR
ESSEX JUNCTION VT
05452-3867
US

V. Phone/Fax

Practice location:
  • Phone: 802-644-8811
  • Fax:
Mailing address:
  • Phone: 802-872-9318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3338
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: