Healthcare Provider Details

I. General information

NPI: 1578630067
Provider Name (Legal Business Name): LYNDONVILLE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 10/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 DEPOT ST
LYNDONVILLE VT
05851-9706
US

IV. Provider business mailing address

PO BOX 1068
LYNDONVILLE VT
05851-1068
US

V. Phone/Fax

Practice location:
  • Phone: 802-626-6966
  • Fax: 802-626-6977
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0383354
License Number StateVT

VIII. Authorized Official

Name: JILL GEIGER
Title or Position: OWNER
Credential: RPH
Phone: 802-751-8438