Healthcare Provider Details

I. General information

NPI: 1730049214
Provider Name (Legal Business Name): DOG RIVER PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 DEPOT SQ STE 1
NORTHFIELD VT
05663-6960
US

IV. Provider business mailing address

14 DEPOT SQ STE 1
NORTHFIELD VT
05663-6960
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. KYLE MAXWELL
Title or Position: PRESIDENT/TREAS.
Credential: PHARMD,RPH
Phone: 802-485-4771