Healthcare Provider Details

I. General information

NPI: 1649283367
Provider Name (Legal Business Name): MARTIN JOSEPH IRONS B.PHARM., CDE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 WOODSTOCK AVENUE
RUTLAND VT
05701
US

IV. Provider business mailing address

20 WASHINGTON STREET
FAIR HAVEN VT
05701-1041
US

V. Phone/Fax

Practice location:
  • Phone: 802-775-4321
  • Fax: 802-775-8211
Mailing address:
  • Phone: 914-443-4259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number033-0003209
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: