Healthcare Provider Details

I. General information

NPI: 1396829420
Provider Name (Legal Business Name): NORTHFIELD PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 12/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 DEPOT SQ
NORTHFIELD VT
05663-6958
US

IV. Provider business mailing address

14 DEPOT SQ
NORTHFIELD VT
05663-6958
US

V. Phone/Fax

Practice location:
  • Phone: 802-485-4771
  • Fax: 802-485-4773
Mailing address:
  • Phone: 802-485-4771
  • Fax: 802-485-4773

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 Number0380003004
License Number StateVT

VIII. Authorized Official

Name: JILL DONAHUE
Title or Position: OWNER
Credential: RPH
Phone: 802-485-4771