Healthcare Provider Details

I. General information

NPI: 1023312964
Provider Name (Legal Business Name): LUDLOW PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2011
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 POND ST
LUDLOW VT
05149-1083
US

IV. Provider business mailing address

57 POND ST
LUDLOW VT
05149-1083
US

V. Phone/Fax

Practice location:
  • Phone: 802-228-2500
  • Fax: 802-228-7209
Mailing address:
  • Phone: 802-228-2500
  • Fax: 802-228-7209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number038.0073109
License Number StateVT

VIII. Authorized Official

Name: JASON HOCHBERG
Title or Position: OWNER
Credential:
Phone: 802-228-2500