Healthcare Provider Details

I. General information

NPI: 1346285921
Provider Name (Legal Business Name): BEAUCHAMP & O'ROURKE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 WOODSTOCK AVE STE 1
RUTLAND VT
05701-3534
US

IV. Provider business mailing address

62 WOODSTOCK AVE STE 1
RUTLAND VT
05701-3534
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0380000553
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. BARRY SCOTT BEAUCHAMP
Title or Position: STORE MANAGER
Credential:
Phone: 802-775-4321