Healthcare Provider Details

I. General information

NPI: 1962520098
Provider Name (Legal Business Name): REBECCA A CRITTENDEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REBECCA A LAMOTHE PHARMD

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/16/2024
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

434 HURRICANE LN STE 300
WILLISTON VT
05495-2073
US

IV. Provider business mailing address

434 HURRICANE LN
WILLISTON VT
05495-2073
US

V. Phone/Fax

Practice location:
  • Phone: 802-655-3544
  • Fax: 802-655-0123
Mailing address:
  • Phone: 802-655-3544
  • Fax: 802-655-0123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number033-0003739
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: