Healthcare Provider Details

I. General information

NPI: 1972045839
Provider Name (Legal Business Name): PHARMACY HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2016
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 STRATTON RD
RUTLAND VT
05701-4623
US

IV. Provider business mailing address

PO BOX 69
MIDDLEBURY VT
05753-0069
US

V. Phone/Fax

Practice location:
  • Phone: 802-775-3351
  • Fax: 802-774-5052
Mailing address:
  • Phone: 802-775-3351
  • Fax: 802-774-5052

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 Number038.0125476
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DIANE GRAY
Title or Position: COO
Credential:
Phone: 802-388-1575