Healthcare Provider Details

I. General information

NPI: 1821045337
Provider Name (Legal Business Name): WILLIS BREEN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 05/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 COURT ST
MIDDLEBURY VT
05753-8986
US

IV. Provider business mailing address

119 HIGHLAND WAY
NORTH FERRISBURG VT
05473-4020
US

V. Phone/Fax

Practice location:
  • Phone: 802-388-9573
  • Fax:
Mailing address:
  • Phone: 802-578-9349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number033-0002937
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: