Healthcare Provider Details

I. General information

NPI: 1134184948
Provider Name (Legal Business Name): PHARMACY HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 MAPLE ST
MIDDLEBURY VT
05753-1595
US

IV. Provider business mailing address

99 MAPLE ST
MIDDLEBURY VT
05753-1595
US

V. Phone/Fax

Practice location:
  • Phone: 802-388-3784
  • Fax: 802-388-1720
Mailing address:
  • Phone: 802-388-3784
  • Fax: 802-388-1720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number038.0003398
License Number StateVT

VIII. Authorized Official

Name: MARIA BURNS
Title or Position: PRESIDENT
Credential:
Phone: 802-893-5105