Healthcare Provider Details

I. General information

NPI: 1508145137
Provider Name (Legal Business Name): MATT M ALTER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2011
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 SWANTON RD
SAINT ALBANS VT
05478-2601
US

IV. Provider business mailing address

164 SWANTON RD
SAINT ALBANS VT
05478-2601
US

V. Phone/Fax

Practice location:
  • Phone: 802-524-5656
  • Fax: 802-524-7269
Mailing address:
  • Phone: 802-524-6543
  • Fax: 802-524-7269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0330003411
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number033.0003411
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: