Healthcare Provider Details

I. General information

NPI: 1497264899
Provider Name (Legal Business Name): CHELSEA PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 04/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

356 VT-110
CHELSEA VT
05038
US

IV. Provider business mailing address

356 VT-110
CHELSEA VT
05038
US

V. Phone/Fax

Practice location:
  • Phone: 802-685-2100
  • Fax: 802-685-3499
Mailing address:
  • Phone: 802-685-2100
  • Fax: 802-685-3499

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 Number038.0129187
License Number StateVT

VIII. Authorized Official

Name: MAYUR PATEL
Title or Position: MEMBER
Credential:
Phone: 845-292-8200