Healthcare Provider Details

I. General information

NPI: 1073606364
Provider Name (Legal Business Name): MCGRX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2006
Last Update Date: 04/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 MAIN ST SUITE B
WINOOSKI VT
05404-1380
US

IV. Provider business mailing address

321 MAIN ST SUITE B
WINOOSKI VT
05404-1380
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 Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number0380003337
License Number StateVT

VIII. Authorized Official

Name: THOMAS REARDON
Title or Position: OWNER
Credential:
Phone: 802-655-3544