Healthcare Provider Details

I. General information

NPI: 1922484658
Provider Name (Legal Business Name): REBECCA F TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WOODSTOCK AVE
RUTLAND VT
05701-3514
US

IV. Provider business mailing address

PO BOX 281
BRIDGEWATER VT
05034-0281
US

V. Phone/Fax

Practice location:
  • Phone: 802-773-6980
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number033.0112984
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: