Healthcare Provider Details

I. General information

NPI: 1366736944
Provider Name (Legal Business Name): DEBORAH J DESAUTELS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 11/05/2024
Certification Date: 11/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 SEYMOUR DRIVE
DERBY VT
05829
US

IV. Provider business mailing address

153 MEMPHREMAGOG VW # B3
NEWPORT VT
05855-4937
US

V. Phone/Fax

Practice location:
  • Phone: 802-309-3621
  • Fax:
Mailing address:
  • Phone: 802-309-3621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number033.0003820
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: