Healthcare Provider Details

I. General information

NPI: 1326516618
Provider Name (Legal Business Name): SAMANTHA ANN SAWYER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115B PORTER DR
MIDDLEBURY VT
05753-8423
US

IV. Provider business mailing address

839 ROBERT YOUNG RD
STARKSBORO VT
05487-7152
US

V. Phone/Fax

Practice location:
  • Phone: 802-388-4711
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number3818
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number3818
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: